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10-Hour NCLEX Last-Minute Crash Course | Proven Shortcut to Pass the NCLEX in Your First Try — Transcript

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0:00Hey future nurses, this course is the
0:02fastest, smartest way to pass the ANCLEX
0:04on your first try. If you're serious
0:05about passing, this 10-hour crash course
0:07is your one-stop solution. More than 70
0:09questions in every ANCLEX exam come
0:11directly from the topics covered in this
0:12video. We created this course after
0:14analyzing feedback from 5,000 registered
0:16nurses who successfully passed the ENLEX
0:18in the last 5 years. We've handpicked
0:20100 plus high yield topics that are
0:22repeatedly tested and we're giving them
0:24to you for free. After every topic,
0:25you'll find real enclelex style
0:27questions from previous exams to test
0:28your knowledge instantly. This 10-hour
0:30crash course will save you over 500
0:33hours of study time. But here's the
0:34challenge you need to watch the full 10
0:36hours to get the maximum benefit. Miss
0:38even a few minutes and you might miss a
0:40question on your actual exam. Every
0:41ENCLEX candidate must watch this before
0:43the exam. It's the fastest way to brush
0:45up on key concepts without wasting time
0:47on unnecessary topics. We've designed
0:48this course using animations because
0:50studies show that visual learning helps
0:52retain information longer. This is your
0:53final power revision. Let's get started.
0:55Before we move ahead, let me take a
0:56quick moment to tell you something that
0:58could completely change your ENLEX
1:01journey. If you're serious about passing
1:02the ENCLEX in just one week or even
1:04within a month, then the smartest move
1:06you can make right now is to enroll in
1:08our complete online ENLEX crash course.
1:11This isn't just another course. It's a
1:12shortcut, a clear step-by-step road map
1:14that has already helped over 100,000
1:16nursing students pass the ENLEX with
1:17confidence. And here's the most
1:18incredible part. Not a single student
1:21who completed this course has failed.
1:22Yes, that's a 100% passing rate. We
1:25built this course based entirely on the
1:27feedback and insights of thousands of
1:28nurses who've successfully cleared the
1:30ENC collects in the last 5 years. That
1:32means we've removed all the fluff and
1:33focused only on what truly matters for
1:35your exam. Here's exactly what you'll
1:36get when you enroll. You'll get 100
1:38hours of animated crash course content
1:40designed for rapid revision, 500 hours
1:42of comprehensive recorded lectures
1:44covering all the high yield topics, and
1:45access to 10,000 real Enclelex questions
1:48to sharpen your test taking skills.
1:49You'll also get 500 next-gen case-based
1:51questions to strengthen your clinical
1:53judgment along with 15 fulllength
1:55practice tests that simulate the real
1:57enclelex experience. And of course,
1:58you'll receive our complete Enclelex
2:00ebook and PDF notes, plus one full year
2:02of access so you can study at your pace
2:04on your schedule. And yes, we're
2:06currently offering a 70% discount for a
2:08very short period. Once the offer ends,
2:10it's gone. Thousands of students are
2:11enrolling in our online ENLEX course
2:13every month and passing the exam, but if
2:14you don't enroll now, you risk being
2:16left behind. Spots are filling fast and
2:18only a few seats are left. Visit our
2:20website to enroll now. Link is given in
2:22description box. Let's continue the
2:23video. This lecture is about cardiac
2:26drug, calcium channel blockers, ECG
2:29rhythm, chest tube, congenital heart
2:33diseases, infectious disease,
2:36transmissionbased
2:37precautions and doses calculation. You
2:41just have to know some basics about
2:43these heart drugs. Somewhere in the
2:46margin of this lecture, I want you to
2:48write the following. Calcium channel
2:51blockers are like Valium for your heart.
2:54It's easy for you to remember what they
2:56do. What does volume do for your body
3:00and for you in general? What's the
3:02difference? It calms you down. So, what
3:05do you think calcium channel blockers do
3:08to the heart? They calm it down. So, if
3:11you get a question about a calcium
3:13channel blocker, think, "Oh, that's
3:16going to calm my heart down."
3:19That would be just like giving my heart
3:21some volume. Now, did I say it was
3:24volume? No, it's not val. It has nothing
3:28to do with volume. But it's like volume
3:31for your heart. So, if your heart is
3:34techicardic, could it stand a little
3:37relaxing?
3:38Yes. So, what class of drug could you
3:40give? Calcium channel blocker. If you're
3:43in shock, does your heart need to relax
3:46when you're in shock? No. So, would you
3:49give a calcium channel blocker? No. If
3:51your heart was in a heart block, would
3:54you give a calcium channel blocker? No.
3:56If your heart was having a tacky
3:58arhythmia, would you give a calcium
4:00channel blocker? If you had a heart
4:03attack and you wanted to rest your
4:06heart, what would you give? A calcium
4:08channel blocker. So, calcium channel
4:11blocker is given when you want to rest
4:14your heart. When your heart needs
4:16stimulation, please don't give a calcium
4:19channel blocker. So in this way, it is
4:23like volume for your heart. So how do we
4:26say that really fancy? The way we say
4:29that fancy is the following. A calcium
4:32channel blockers are negative inotropic,
4:36chronotropic, and droopic. When you see
4:40the fancy words negative inotropic,
4:42negative chronotropic, and negative
4:44droopic,
4:46don't freak out. All that's saying is
4:49that it's like volume for your heart. So
4:52negative inotropes, negative
4:55chronotropes, and negative droopes
4:58relax your heart. They calm it down. Now
5:02the chart below shows you the difference
5:04between the positive inotrope
5:06chronotrope and chromatropes
5:09and the negative inotrope chronotrope
5:12droopes. What do positive chronotrope
5:15positive inotrope and positive droope
5:18do? They strengthen and speed up
5:21stimulation. So they are called cardiac
5:24stimulants. Negative chronotrope,
5:27negative inotrope and negative droopes
5:30are cardiac depressants. They are
5:33negative because they weaken, slow down
5:37and depress the heart. B.
5:40When would we want to do that? What do
5:44they treat? Well, they treat small aaa
5:49and big a aaa.
5:52The first small A stands for
5:55anti-hypertensives.
5:57They relax your heart and blood vessels.
6:00If you relax your heart and blood
6:02vessels, your blood pressure goes down.
6:06If your blood pressure was high, would
6:09you take volume for your heart or a
6:12stimulant for your heart?
6:14Valium? That would mean you'd use a
6:17calcium channel blocker. The second and
6:21third small A stand for anti-agal.
6:25They are anti-agena drugs. It's going to
6:29relax your heart. So, it uses less
6:31oxygen by decreasing oxygen demand. It
6:35treats angina by decreasing oxygen
6:38demand because it relaxes the heart.
6:41What's the worst thing in the world for
6:43a person with angina? What's the worst
6:46thing that can happen to their heart? It
6:48speeds up.
6:49Big A a anti-atrial
6:53arhythmia. So what does it treat? Will
6:56it treat ventricular tachicardia? No.
6:58Why? Because that's ventricular. And
7:02this only treats atrial. Will it treat
7:05atrial flutter? Yes. Premature atrial
7:08contractions? Yes. Proxismal atrial
7:11teachardia? Yes. Atrial bgeiny? Yes.
7:15Ventricular bgeiny? No. Atrial
7:19fibrillation.
7:20Yes. Premature ventricular contractions.
7:25No. So, all you have to know is to know
7:28if it starts with the letter A. If it's
7:31an A, it's yes. And if it's a V, it's
7:35no. But there's a trick about this one.
7:38Supra ventricular teicardia. SVT. Would
7:42calcium channel blockers treat SVT? Yes
7:45or no? I'm going to say yes. But why?
7:49What does supra mean? And what's above
7:52the ventricles? Atrial. So supra
7:55ventricular is the only ventricular
7:58which is actually saying atrial. It
8:01treats a small aa and big a aaa.
8:07What are the side effects?
8:09H and h. The letter h is your friend
8:14here. headache and hypotension. Why
8:18hypotension? Because it relaxes the
8:21heart and the blood vessels. Why the
8:24headache? Because you get vasodilation
8:26in the brain and that gives you a
8:28migraine. By the way, headache is a
8:31great thing to check on. A select all
8:34that apply. What do you have with low
8:36sodium? Headache. What do you have with
8:39high glucose? Headache. What do you have
8:42with high blood pressure? A headache.
8:45What do you have with low blood
8:47pressure? A headache. What do you have
8:50with low glucose? Headache. What do you
8:53have with high sodium? Headache. Okay.
8:57Names of calcium channel blockers.
9:00Anything ending in depine, alomine,
9:04nefine,
9:06the depines. I always say you're dipping
9:09in the calcium channel, not pine. So why
9:12not pine? Why would you want to memorize
9:15anything ending in pine? Because there
9:19are loads of drugs that end in pine.
9:23It has to be a dipine. Dipine is your
9:27calcium channel blocker ending. And then
9:29there are two others you have to know by
9:32name. Verapamil and cartism. Those are
9:36your calcium channel blockers. Which of
9:39those is a continuous IV drip that can
9:41be given? Cortism. So when you give a
9:44calcium channel blocker, what vital
9:46signs do you need to measure before you
9:48get it? Blood pressure, what's the side
9:51effects? Hypertension, what are your
9:53parameters? What are your guidelines?
9:57Measure the blood pressure. And if the
9:59systolic is under 100, then you hold the
10:03calcium channel blocker. You have to
10:05monitor the blood pressure continuously
10:08or fairly quickly intermittently while
10:10they're on a cartism drip. If it was 98
10:13over 52 mm of Hg, what would you do with
10:17the drip? Slow it down. Measure it again
10:20so you titrate. And by titrate, I mean
10:23changing the IV rate to keep the blood
10:26pressure up and the systolic over 100 mm
10:29of Hg. They would say, if somebody's on
10:32a cartism drip, which of the following
10:35would you report to the RN? It's a
10:37systolic blood pressure falling below
10:40100 mm of Hg. Before we move ahead, let
10:43me take a quick moment to tell you
10:44something that could completely change
10:47your ENLEX journey. If you're serious
10:49about passing the ENLEX in just one week
10:51or even within a month, then the
10:53smartest move you can make right now is
10:54to enroll in our complete online
10:57enclelex crash course. This isn't just
10:58another course. It's a shortcut, a clear
11:00step-by-step road map that has already
11:02helped over 100,000 nursing students
11:04pass the ENCLEX with confidence. And
11:05here's the most incredible part. Not a
11:07single student who completed this course
11:09has failed. Yes, that's a 100% passing
11:11rate. We built this course based
11:13entirely on the feedback and insights of
11:15thousands of nurses who've successfully
11:17cleared the ENCLEs in the last 5 years.
11:19That means we've removed all the fluff
11:20and focused only on what truly matters
11:22for your exam. Here's exactly what
11:23you'll get when you enroll. You'll get
11:25100 hours of animated crash course
11:27content designed for rapid revision, 500
11:29hours of comprehensive recorded lectures
11:31covering all the high yield topics, and
11:32access to 10,000 real Enclelex questions
11:35to sharpen your test taking skills.
11:37You'll also get 500 NextGen case-based
11:39questions to strengthen your clinical
11:40judgment along with 15 fulllength
11:42practice tests that simulate the real
11:44enclelex experience. And of course,
11:46you'll receive our complete enclelex
11:47ebook and PDF notes, plus one full year
11:50of access so you can study at your pace
11:51on your schedule. And yes, we're
11:53currently offering a 70% discount for a
11:55very short period. Once the offer ends,
11:57it's gone. Thousands of students are
11:58enrolling in our online enclelex course
12:00every month and passing the exam. But if
12:02you don't enroll now, you risk being
12:03left behind. Spots are filling fast and
12:05only a few seats are left. Visit our
12:07website to enroll now. Link is given in
12:09description box. Let's continue the
12:10video. Cardiac arhythmias.
12:13Knowing how to interpret rhythm strips.
12:16There are four rhythm strip tracings
12:19that you must know by sight. The first
12:22one is normal sinus rhythm. How do you
12:25know it is normal sinus rhythm? There's
12:28a Pwave, a QRS, and a T-wave for every
12:33single complex. There's a Pwave before
12:37every QRS, and every QRS is followed by
12:41a T-wave.
12:43And what else tells you it is a normal
12:45sinus rhythm? The peaks of the Pwaves
12:49are equally distant from each other.
12:51That tells you you are not dealing with
12:54something called a sinus arhythmia. So
12:57it is a normal sinus rhythm. Because
12:59there's a P for every QRS and the QRS
13:03complexes are evenly spaced. When you
13:06see that it is a normal sinus rhythm, it
13:09doesn't really matter if they go up or
13:12down. You could have a Pwave going up
13:14and the QRS is going down and that's
13:17okay. That's still normal science. The
13:21second one is VIB, ventricular
13:24fibrillation.
13:26It is a chaotic squiggly line. The third
13:30one looks like a 1960 wallpaper border.
13:34That's VTAC, ventricular tachicardia.
13:38It's got these sharp peaks and jacks.
13:41Is there a pattern? Yeah. Is there a
13:43pattern with ventricular fibrillation?
13:46No, there's no pattern with VIB. But
13:50there is a pattern with VTAC. And the
13:53last one is called acy. Whenever the
13:56question says QRS deolarization,
13:59it's talking about ventricular. You can
14:02always narrow it down to one of two that
14:05would say the word ventricular.
14:07You can rule out anything that says
14:09atrium.
14:11And if you see QRS,
14:13you can rule out anything that says
14:15atrial and go with what's ventricular.
14:19However, number two, if it says Pwave,
14:23that will refer to something atrial, and
14:26you can rule out anything ventricular
14:28unless they say a lack of a Pwave. Well,
14:33I mean, that's not really talking about
14:35it. The six rhythms most tested on
14:38enclelex.
14:40Number one, they will use the phrase a
14:44lack of QRS's.
14:47There are no QRS's. That's called a cy.
14:51That's a flat line. Number two, as to be
14:54a form of what? Atrial.
14:58Why does it have to be atrial? Because
15:00of the Pwave.
15:02When you see saw tooth, you always pick
15:06flutter. Flutter is always described as
15:10saw. Number three, if you notice that
15:14they have the same adjective, the word
15:16chaotic. Chaotic is always the word used
15:20to describe fibrillation. Number four,
15:23ventricular fibrillation.
15:26How did you know it was ventricular? How
15:28did you know it's fibrillation? Chaos.
15:32Number five. Some form of what? Atrial
15:36or ventricular? Ventricular.
15:39How do you know it's ventricular? Q R S.
15:44When it says bizarre, bizarre always
15:48applies to tachicardia.
15:50Bizarre is the word they use for
15:52tachicardia.
15:54Chaos is the word they use for
15:56fibrillation. So if you put two and two
15:59together, what is number five?
16:02Ventricular tachicardia.
16:05Now what about a periodic wave bizarre
16:08QRS as a PVC?
16:11Why is it ventricular and why is it wide
16:14and bizarre?
16:16This is like one snapshot of
16:18tachicardia.
16:20It's just one piece of tachicardia. So
16:24is it possible that you could call a
16:25salvo of PVCs?
16:28you know a thousand of them, a group of
16:30them in a row of salvo. What else could
16:32you call it? A short run of the attack
16:35because it's the same idea. Do
16:38physicians care about people having
16:40PVCs? Generally speaking, no. How high a
16:44priority is a client with a PVC? If you
16:47had to prioritize four clients and one
16:50of them has PVC, low, moderate, or high?
16:55Low. Under three circumstances, you
16:57could elevate that person to moderate.
17:00Not high priority, just moderate
17:02priority. One, if there are more than
17:05six PVCs in a minute. Two, more than six
17:08PVCs in a row. Or three, if the PVC
17:12falls on the T-wave of the previous
17:14beat. That's called the R on T
17:18phenomenon. If one of these happens, you
17:21elevate the priority of your PVC client
17:24to moderate. PVC's never reach high
17:27priority. The most the PVC client can
17:29reach is moderate. After a heart attack,
17:32even if they're having PVCs, is that
17:35good or bad? It's actually good because
17:39it means they're reprofusing. So, it
17:41doesn't raise their priority. It
17:43actually lowers it because they're doing
17:45great. Lethal arythmus. How high a
17:49priority are these? These are high
17:52priorities.
17:54There are two of them that are super
17:56high priorities. They're lethal, meaning
17:59they will kill you in 8 minutes or less.
18:02The first one is acy. If you are
18:05alostolic, you have 8 minutes or that
18:09brain is gone. VIB is the other lethal
18:13one. What do acy and vib have in common?
18:17no cardiac output. If you've got no
18:20cardiac output, you do not have brain
18:22profusion. And if you don't have brain
18:24profusion, you're dead in 8 minutes. So
18:28if they give you four patients and one
18:30of the patients has acy or vib, how high
18:34do you prioritize that patient? They're
18:36probably number one. One of these
18:39arhythmiases is potentially
18:41life-threatening.
18:43It is not lifethreatening.
18:46It is only potentially life-threatening
18:49but that still makes it a fairly high
18:51priority and that is ventricular
18:54tachicardia. So therefore what is the
18:57difference between VTAC and the acyist
19:00VIBs? VTAC has a cardiac output. If
19:03there's no pulse there's no cardiac
19:06output. It's just as bad as what was
19:09there before.
19:10Treatment. The first two are PVC's and
19:13VTAC. They are both ventricular.
19:17For ventricular, use lidocaine. You know
19:21that lidocaine is not used in a lot of
19:23squads now in the bigger cities because
19:26they're using aminoderone. But boards is
19:29going to talk more about lidocaine after
19:31April 1st. So it would be aminoderone.
19:36Supra ventricular arhythmias. What's the
19:39synonym for supra ventricular arhythmia?
19:43Atrial arhythmias. For treatment of
19:45atrial arhythmias, use the ABCDs.
19:49Atrial starts with the letter A. So
19:51remember the ABCDs of atrial treatment.
19:54So for ventricular, use lidocaine. For
19:58atrial, use the ABCDS. A stands for
20:02adenocard. This is the one you have to
20:05push in less than 8 seconds. So is it a
20:09fast or slow IV push? fast. No, it's
20:14super fast. You've got 8 seconds. They
20:17call it slamming. Have you ever heard
20:19that you've got to slam this drug?
20:21You've got to push it in in 8 seconds
20:23and then the other nurse pushes 20 ml of
20:26flush right after it. So, you've got to
20:28use a big vein. The problem with this
20:30though is when you slam it fast, what
20:33could they go into? A cy for about 30
20:37seconds, but they'll come out of it. B
20:40stands for beta blockers. What do all
20:43beta blockers end in? LOL, carvettool,
20:46bredol, and propranolol are all beta
20:50blockers. This is the best name class of
20:53drugs in the universe. Every drug that
20:56is a LOL is a beta blocker. Beta
21:00blockers are negative inotropic,
21:03negative chronotropic, and negative
21:05droopic.
21:07So they're like volume for your heart.
21:10So they'll treat AA and AAA, right?
21:13Anti-atrial arrhythmia. So what will
21:17beta blockers have as side effects?
21:19Headache and hypotension, but don't make
21:21a big difference between calcium channel
21:24blockers and beta blockers. Calcium
21:26channel blockers are better for people
21:28with asthma because beta blockers bronco
21:32constrict. So people that have other
21:34diseases like COPD probably should be on
21:38a calcium channel, although a beta does
21:40all the same things and has all the same
21:43side effects. So what's the C? Calcium
21:47channel blockers. Beta blockers and
21:50calcium channel blockers are like Valium
21:52for your heart. They're negative
21:54inotropic, negative chronotropic, and
21:57negative droopic.
22:00They treat the little AAA and big AAA
22:04and they have the side effects of H and
22:06H both of them. The D stands for
22:10digitalis, dyoxin and lenoxin. You have
22:15to know these names because they will
22:17only give you one name for this drug.
22:20They'll say lenoxin. You're supposed to
22:23know that's digitalis. Here's the
22:26overview of ABCD to treat atrial
22:28arhythmias. A dinner card, B beta
22:32blocker, C calcium channel blocker, and
22:36D digitalis.
22:39What do you use for VIB? It rhymes,
22:42right? For VIB, you defib. What do you
22:45use for acistles? Epinephrine and
22:47atropene. In that order, what's the
22:51first one you give? Epinephrine. Then if
22:54that doesn't work, you give atropene.
22:57Now the way I remember this is to look
23:00at the word acisty, the first letter A
23:03which stands for atropene. The last
23:06letter E which stands for epinephrine
23:09but give it in reverse. So meaning in
23:12acisty give epinephrine first. Before we
23:15move ahead let me take a quick moment to
23:17tell you something that could completely
23:19change your enclelex journey. If you're
23:22serious about passing the ENLEX in just
23:23one week or even within a month, then
23:26the smartest move you can make right now
23:27is to enroll in our complete online
23:29ENLEX crash course. This isn't just
23:31another course, it's a shortcut. A clear
23:33step-by-step road map that has already
23:35helped over 100,000 nursing students
23:36pass the ENCLEX with confidence. And
23:38here's the most incredible part. Not a
23:40single student who completed this course
23:42has failed. Yes, that's a 100% passing
23:44rate. We built this course based
23:46entirely on the feedback and insights of
23:48thousands of nurses who've successfully
23:49cleared the enclelex in the last 5
23:51years. That means we've removed all the
23:53fluff and focused only on what truly
23:54matters for your exam. Here's exactly
23:56what you'll get when you enroll. You'll
23:57get 100 hours of animated crash course
23:59content designed for rapid revision, 500
24:02hours of comprehensive recorded lectures
24:04covering all the high yield topics, and
24:05access to 10,000 reallex questions to
24:08sharpen your test taking skills. You'll
24:10also get 500 NextGen case-based
24:11questions to strengthen your clinical
24:13judgment along with 15 fulllength
24:15practice tests that simulate the real
24:17enclelex experience. And of course,
24:19you'll receive our complete Enclelex
24:20ebook and PDF notes, plus one full year
24:22of access, so you can study at your pace
24:24on your schedule. And yes, we're
24:26currently offering a 70% discount for a
24:28very short period. Once the offer ends,
24:30it's gone. Thousands of students are
24:31enrolling in our online ENLEX course
24:33every month and passing the exam. But if
24:34you don't enroll now, you risk being
24:36left behind. Spots are filling fast and
24:38only a few seats are left. Visit our
24:40website to enroll now. Link is given in
24:42description box. Let's continue the
24:43video. Chest tubes. The purpose of a
24:46chest tube is to reestablish negative
24:48pressure in the plural space. So the
24:51plural space is a place where negative
24:54is good because we don't tend to think
24:57of negative as bad. But negative is good
25:00for your plural space. Negative makes
25:03things stick together. So the purpose of
25:06a chest tube is to reestablish negative
25:09pressure in the plural space so that the
25:11lungs expand when the chest wall moves.
25:14This is why you need that tube in there.
25:17When you get a test tube question, look
25:20at the reason for which it was placed.
25:23Number one, in a numoththorax, the chest
25:26tube removes air. Numo means air. So in
25:31a normthorax, positive pressure is
25:33created by air. So I've got to put a
25:36chest tube in to remove the air so I can
25:39reestablish the negative pressure. But
25:42in a hemothorax, the chest tube removes
25:45blood, right? Because what causes the
25:48positive pressure? Blood. And I have to
25:51remove it to reestablish the negative
25:53pressure. In a numo hemothorax,
25:56what's in the plural space? Air and
25:59blood. and I must remove both air and
26:02blood to reestablish the negative
26:04pressure in the plural space. So if you
26:08have a question that says you have a
26:10patient with hemo with chest tubes in
26:13for a heoorax,
26:15what would you report to the nurse or
26:17the doctor? One, the chest tube is not
26:20bubbling. Two, the chest tube drained
26:22800 ml in the first 10 hours. Three, the
26:26chest tube is not draining. or four. The
26:30chest tube is intermittently bubbling.
26:32What does a heo chest tube put in for a
26:35hemothorax? What's it supposed to drain?
26:38So, which one of these says it's not
26:41doing what it's supposed to do? Number
26:43three. So, which one would you report to
26:45the nurse or the physician? Number
26:47three, because it's not doing what it's
26:50supposed to do. Now, what if this said
26:53pneumothorax? For pumothorax, what would
26:56you report to the physician? Well, you
26:58could have two of them. What would they
27:00be? One or two. It needs to bubble. It's
27:04not doing what it's supposed to do.
27:06What's wrong with number two, then? It's
27:08doing something it's not supposed to do
27:10in that case. And that would be hard.
27:12But the point is that you see how it is
27:15definitely not number three. With a
27:17change from hemo to numo, what was the
27:21right answer is no longer an option for
27:23the right answer. So if you're going to
27:25get just two questions correct, what
27:28must you pay particular attention to in
27:31this disease for which it was placed and
27:34that will tell you what you should
27:36expect. The other thing you have to pay
27:38attention to is the location of the
27:40tubes and the two locations are apical
27:44and baselar. Ale means the test tubes
27:47way up high. And if you put a chest tube
27:50way up high, air will be removed because
27:53air rises. So apical removes air.
27:56Baselars are at the bottom of the lungs.
27:59So they will remove blood because blood
28:01is subject to gravity. So apical removes
28:04air and baselar removes blood. A for a B
28:09for B. Apical starts with A and that
28:11removes air which starts with A and
28:14baselar starts with B and it should
28:17remove blood. So if they say that your
28:21apical chest tube is draining 300 ml per
28:24hour, do you think that is good or bad?
28:28Bad. Your baselar is draining 200 ml per
28:32hour and it needs to come out. Your
28:34apical tube is not bubbling. Bad. Your
28:37apical tube is bubbling. Good. Your
28:40basselar tube is not bubbling fine. Your
28:43basselar tube is bubbling bad. Now, this
28:48brings up the next three questions.
28:50Number one, how many chest tubes and
28:53where would you place them for
28:54unilateral numo hemothorax? Two, you'd
28:59use an apical for the numo and a baselar
29:02for the hemo. Question two, how many
29:04chest tubes and where for a bilateral
29:07numo? Two, they would be both ale. So
29:11you'd use an apical on the right and an
29:13apical on the left. Number three, how
29:15many chest tubes and where would you
29:18place them for postop chest surgery?
29:21two, an apical and a baselar on the side
29:24of the surgery because you are to assume
29:27that chest surgery or trauma is
29:29unilateral unless otherwise specified.
29:33Now, here's a trick question about the
29:35chest tube. How many test tubes would
29:37you need and where would you place them
29:39for a post-op right pneuminctomy? None.
29:43Pneumonctomy means the removal of the
29:46lung. There is no lung. There's no
29:49plural space. there's nothing. So if
29:52there's no plural space, why do you want
29:55to reestablish pressure in something
29:57that does not exist?
29:59So you do not use test tubes for
30:02pneuminctomies. You use them for wedge
30:04resections and lobectomies. Now let's
30:06talk about troubleshooting. What do you
30:09do if you knock over one of those
30:11close-range drainage devices? I mean,
30:14you didn't break it. You just knocked it
30:15over. You set it back up and have the
30:18patient take some deep breaths. It's not
30:21a medical emergency. You don't need to
30:24alert the physician. And what do you do
30:26if the water seal drainage breaks?
30:29Now, that's a totally different thing
30:32now because now positive pressure can
30:34get into the plural space. Clamp it.
30:37That's the first thing you do. So,
30:38nothing gets in. You need to cut it away
30:40from the broken device because it's not
30:42good anymore. So, cut it all away. Take
30:45that tube underwater. It's better to be
30:47underwater because air can't go in, but
30:50stuff can come out. But if it's clamped,
30:53nothing can go in or out. And you want
30:56stuff to come out, but you don't want
30:58stuff to go in. So clamping is only a
31:02stop gap measure. It doesn't solve the
31:04problem. Now, what can we do to solve
31:06the problem? Sticking the tube
31:07underwater to seal it. And what is the
31:10order for this whole procedure? It's
31:11alphabetical. Clamp, cut, submerge,
31:15unclamp. That's the order. So, if they
31:18said to you, "What is the first thing
31:20you're going to do when the water seal
31:22breaks?" You clamp the tube. When they
31:25say first, they're talking about what
31:27order. So, what is the best thing to do
31:30when the water seal breaks? The answer
31:32is submerge it underwater.
31:35Clamping is not the best answer for
31:37water seal breaks because it's just a
31:40temporary fix. Clamping is the first
31:42action you will take in this case, but
31:44it's not the best for this problem. So,
31:48in a water seal break, if they ask for
31:50first action, the answer will be
31:53clamping. But if they ask for only the
31:56best action from these four actions in
31:58case of a water seal break, the answer
32:01will be submerge the tube underwater.
32:04So, first action clamping. Best action,
32:08submerge the tube underwater. Now, what
32:11do you do if the chest tube gets pulled
32:13out? The first thing you do is take a
32:16gloved hand and cover the hole. The best
32:19thing to do is cover it with Vaseline
32:22gauze. The real problem here will be
32:24solved by covering the hole by Vaseline
32:26gauze. Now, we will discuss about
32:28bubbling. Bubbling in chest tube
32:31drainage systems. On these, ask yourself
32:33two questions.
32:35Where is the bubbling and when is the
32:39bubbling? Because sometimes bubbling is
32:41good and sometimes it's bad depending on
32:43when and where. Intermittent bubbling in
32:46the water seal is good. If bubbling is
32:48continuous in a water seal, it's bad.
32:51There's a leak. You do not want
32:53continuous bubbling in the water seal,
32:55which means there's a leak in the
32:57system. Intermittent bubbling in the
32:59suction control chamber is bad. The
33:01suction is not high enough in that case.
33:04You're only getting intermittent
33:06bubbling in the suction control because
33:08your suction is too low. You've got to
33:11go to the dial at the wall and you've
33:13got to turn it up until it bubbles.
33:15Continuous bubbling in the suction
33:17control chamber is good. So, two
33:20scenarios are good and two scenarios are
33:23bad. The two chambers are opposite.
33:26What's good in one is bad in the other.
33:28If something is sealed, there shouldn't
33:30be continuous bubbling. If continuous
33:32bubbling is in a water seal chamber, it
33:35means it's leaking, so that's bad.
33:37Intermittent bubbling in the water seal
33:39is good, but in the suction control,
33:43intermittent bubbling is bad. Rules for
33:46clamping tubes. Number one, you're not
33:49allowed to clamp chest tubes for longer
33:51than 15 seconds without a doctor's
33:53order. So, if you break the water seal,
33:56you've got 15 seconds to get that thing
33:58off and underwater. Number two, use
34:01rubber tip double clamps to avoid
34:03puncturing the tube. Before we move
34:05ahead, let me take a quick moment to
34:07tell you something that could completely
34:09change your enclelex journey. If you're
34:12serious about passing the enclelex in
34:13just one week or even within a month,
34:15then the smartest move you can make
34:17right now is to enroll in our complete
34:19online enclelex crash course. This isn't
34:21just another course. It's a shortcut, a
34:22clear step-by-step road map that has
34:24already helped over 100,000 nursing
34:26students pass the ENLEX with confidence.
34:28And here's the most incredible part. Not
34:29a single student who completed this
34:31course has failed. Yes, that's a 100%
34:34passing rate. We built this course based
34:36entirely on the feedback and insights of
34:38thousands of nurses who've successfully
34:39cleared the enollex in the last 5 years.
34:41That means we've removed all the fluff
34:43and focused only on what truly matters
34:44for your exam. Here's exactly what
34:46you'll get when you enroll. You'll get
34:48100 hours of animated crash course
34:49content designed for rapid revision, 500
34:52hours of comprehensive recorded lectures
34:53covering all the high yield topics, and
34:55access to 10,000 real Enclelex questions
34:58to sharpen your test taking skills.
34:59You'll also get 500 nextgen case-based
35:01questions to strengthen your clinical
35:03judgment along with 15 fulllength
35:05practice tests that simulate the real
35:07enclelex experience. And of course,
35:08you'll receive our complete Enclelex
35:10ebook and PDF notes, plus one full year
35:12of access so you can study at your pace
35:14on your schedule. And yes, we're
35:15currently offering a 70% discount for a
35:18very short period. Once the offer ends,
35:19it's gone. Thousands of students are
35:21enrolling in our online ENCLEX course
35:23every month and passing the exam. But if
35:24you don't enroll now, you risk being
35:26left behind. Spots are filling fast and
35:28only a few seats are left. Visit our
35:30website to enroll now. Link is given in
35:31description box. Let's continue the
35:33video. Congenital heart defects. Every
35:35congenital heart defect is either
35:37trouble or not trouble. It's either all
35:40bad or all good. Nothing in between. I
35:44want you to memorize one word and only
35:48one word and that word is trouble.
35:53Now you notice it has seven letters.
35:55Write the word trouble but capitalize
35:58the consonants. Keep the vowels small
36:01and lowerase. Capital T, capital R,
36:05small O, small U, capital B, capital L,
36:10small E. You don't make the diagnosis,
36:15the radiologist does. Your role in
36:17congenital heart effect is teaching the
36:19patients the implications.
36:22If it's trouble, teach them how it's
36:24going to be a lot of trouble. But if
36:26it's not trouble, pick the answer that
36:30says this is not trouble. They always
36:33want to know, does the defect shunt
36:36blood right to left or left to right?
36:40because R comes before L in the word
36:44trouble. So, a trouble defect shunts
36:46blood from the right to left. No trouble
36:49defects shunt blood left to right
36:51because that's not the way trouble is
36:53spelled because it's not trouble. The
36:56other thing they want to know is if the
36:59kid is cyanotic or asyanotic. Cyanotic
37:02means blue. The letter B in trouble can
37:07help us remember that right to left
37:09shunts are blue. So left to right means
37:12not blue which is pink or asyinotic. Now
37:17there are 40 congenital heart defects.
37:20Some of them are trouble and some of
37:22them are not trouble. It just so happens
37:24by total sheer coincidence that all
37:27congenital heart defects which start
37:29with the letter T are trouble. If it
37:32does not start with the letter T, it's
37:34not trouble. For example, a patient with
37:37ventricular septile defect. Ventricular
37:40is not trouble because it starts with a
37:43V. That's not a T. So, it's not trouble.
37:46It shuts blood from the left to the
37:48right. The child is asyanotic. Tetrology
37:52of phallot starts with a T and that
37:54means it's trouble. It shunts blood
37:56right to left. It's cyanotic. Patented
38:00ductus arteriosis starts with the letter
38:02P. It's not a T. So it's not trouble. It
38:05shunts blood from left to right. So the
38:07child is a cyanotic. Patent for
38:10ramenoval PFO starts with the letter P.
38:14So that's not T and it's not trouble. It
38:17shunts blood from the left to right. So
38:20the child is asyanotic. Trunus
38:22arteriosis starts with the letter T and
38:25that means it is trouble. Shunting of
38:27blood from right to left. The child is
38:30cyanotic. Transposition of the great
38:32vessel. It starts with the letter T. So
38:35it is trouble. Shunting blood from the
38:38right to the left. The child will be
38:40cyanotic. Tricuspidatresia.
38:43It starts with the letter T. So it's
38:45trouble. Shunting of blood will be from
38:48the right to the left. The child will be
38:50cyanotic. Atrial septile defects. It
38:53starts with the letter A. It's not tea,
38:56so it's not trouble. It shunts blood
38:58from the left to right. The child is a
39:00cyanotic. Totally anomalous pulmonary
39:03vascule. T APV. It starts with the
39:06letter T. So it's trouble. Shunting of
39:09blood will be from the right to left.
39:11And the child cyanotic. All congenital
39:14heart defects for kids will have two
39:16things whether trouble or not trouble.
39:19Number one, they'll all have a murmur.
39:22They all have murmurss because they are
39:24shunting the blood. Either something
39:26from the left to the right or from the
39:28right to the left. You will hear a
39:31murmur. Number two, they all have an
39:34echo cardiogram done. Even your no
39:37trouble kids will have an echo
39:39cardiogram done. The last thing about
39:41congenital heart defects is that you
39:44need to know the four defects of the
39:46tetrology of phallot.
39:49The best way I know is the saying varied
39:52pictures of a ranch. Capitalize the
39:54first and last letters of each word.
39:57You've got V D P S O A R H. You can also
40:04memorize this by the sentence
40:06Valentine's Day. Pick someone out a red
40:10heart. But if you choose this method,
40:13then please do capitalize the first
40:15letter of all the words. Then make a
40:18group of each of the two capitals like
40:21this V D O A and RH. Those are the
40:26initials of the four defects. So varied
40:29becomes VD. VD stands for ventricular
40:32defect. PS stands for pulmonary
40:35stenosis. OA stands for overriding
40:38aorta. And RH stands for right
40:41hypertension. For all congenital heart
40:44diseases, you have to remember two
40:47words,
40:49trouble and vo a r. Before we move
40:54ahead, let me take a quick moment to
40:55tell you something that could completely
40:57change your enclelex journey. If you're
41:00serious about passing the enclelex in
41:02just one week or even within a month,
41:04then the smartest move you can make
41:05right now is to enroll in our complete
41:07online enclelex crash course. This isn't
41:09just another course. It's a shortcut, a
41:11clear step-by-step road map that has
41:13already helped over 100,000 nursing
41:15students pass the ANCLEX with
41:16confidence. And here's the most
41:17incredible part. Not a single student
41:19who completed this course has failed.
41:21Yes, that's a 100% passing rate. We
41:23built this course based entirely on the
41:25feedback and insights of thousands of
41:27nurses who've successfully cleared the
41:28ENCLEs in the last 5 years. That means
41:30we've removed all the fluff and focused
41:32only on what truly matters for your
41:33exam. Here's exactly what you'll get
41:35when you enroll. You'll get 100 hours of
41:37animated crash course content designed
41:39for rapid revision. 500 hours of
41:41comprehensive recorded lectures covering
41:42all the high yield topics and access to
41:4410,000 real enclelex questions to
41:46sharpen your test taking skills. You'll
41:48also get 500 NextGen case-based
41:50questions to strengthen your clinical
41:51judgment along with 15 fulllength
41:53practice tests that simulate the real
41:55enclelex experience. And of course,
41:57you'll receive our complete enclelex
41:59ebook and PDF notes, plus one full year
42:01of access so you can study at your pace
42:03on your schedule. And yes, we're
42:04currently offering a 70% discount for a
42:06very short period. Once the offer ends,
42:08it's gone. Thousands of students are
42:09enrolling in our online enclelex course
42:11every month and passing the exam. But if
42:13you don't enroll now, you risk being
42:15left behind. Spots are filling fast and
42:16only a few seats are left. Visit our
42:18website to enroll now. Link is given in
42:20description box. Let's continue the
42:21video. Infectious disease and
42:24transmissionbased precautions. There are
42:27four transmissionbased precautions.
42:30Standard universal
42:32contact droplet and airborne. Contact
42:37isolation is for anything anteric which
42:40means what it can be caught from the
42:42intestine fecal oral. So that would be C
42:45diff crossidium difficult hepatitis A
42:48would be there that's anteric that's
42:50intestinal any of those calora dysentery
42:53you know those ones where the bugs and
42:55diarrhea and you don't wash your hands
42:57and then you touch somebody and then
42:59they eat their food. People get confused
43:02about hepatitis A and hepatitis B and
43:04which one is which. I always say
43:06hepatitis A. The A stands for anus. I
43:10mean it doesn't. But for hepatitis A,
43:13think hepatitis anus, which tells you
43:16it's fecal oral. Hepatitis B is
43:18hepatitis blood, so it's by the blood.
43:21Another one used for contact is staff
43:23infections, staff and RSV, respiratory
43:27sync virus. The interesting thing about
43:30RSV is that it's transmitted by
43:32droplets, but it's on the precautions
43:35for contact because little kids catch it
43:38from touching other things that other
43:39kids touch and put in their mouth. Staff
43:42RSV and herpes are contact isolation.
43:46So, what's involved in contact
43:48isolation? I'm going to give you all the
43:50latest newest things because some things
43:53have changed in contact. They are now
43:56saying a private room is preferred. So
43:58therefore, while it's not required, it
44:01is preferred. Therefore, you would say
44:04yes to the private room. However, these
44:07kids can be put in the same room as long
44:09as you cohort. So, if you've got two RSV
44:13kids, you can put them in the same room.
44:16Yes, but otherwise, an RSV needs to be
44:20in their own room. However, an RSV kid
44:24with a suspected RSV kid cannot be put
44:27in the same room. They have to be
44:29cultured and positive before you can put
44:32them in the same room. Cohorting is done
44:35on the basis of culture, not on the
44:38basis of symptoms. Droplet is for bugs
44:41that travel 3 ft on large particles due
44:44to sneezing and coughing. Therefore
44:46menitis all menitis and H flu hemophilus
44:50influenza B are more likely to cause
44:53epiglotus. So a private room is
44:56preferred but not required. It's
44:58preferred. So on boards you would select
45:01private room. It's preferred unless you
45:04are cohorting based on culture. If it is
45:07menitis they all have lumbar punctures
45:10because that's where menitis is
45:12cultured. Airborne is for measles,
45:15mumps, reubella, tuberculosis, and
45:18valicella chickenpox. Now, the private
45:21room is required unless you're a cohort.
45:24A special mask filter is only for
45:26tuberculosis patients. Disposable
45:29supplies and dedicated equipment are
45:31probably a good thing, but it's not an
45:34essential as in the other two. So, you
45:38could let that one slide. You could
45:41because it's airborne, not droplet or
45:44contact and negative air flow. Yes. Now
45:48the interesting thing about tuberculosis
45:50is the method by which it is spread. It
45:52spreads by droplet but it's on the
45:55airborne precautions. RSV and TB are
45:59both droplets. One contact, the other is
46:02airborne, but they're both transmitted
46:05via droplet. The other thing that I want
46:07you to know is personal protective
46:10equipment, PPE.
46:12And they want you to know what order you
46:15put it on and what order you take it
46:17off. You always take it off in
46:20alphabetical order. Gloves followed by
46:23goggles followed by a gown followed by a
46:28mask. Putting off is alphabetical.
46:30Putting on is the reverse alphabetical
46:32for the G's, but mask comes second. So,
46:36gown, mask, goggles, gloves. The first
46:41two are what we call dosage calculation.
46:44It's when what the doctor orders isn't
46:46what's on the bottle. There's no
46:49conversion involved. It's just a simple
46:52desired over half times available. Or if
46:55you're like me, just set up a ratio
46:57proportion. The next one is the IV drip
47:00rates. And these are mostly for the RNs.
47:03You're going to have to know these LPNs.
47:07You may not have to know these, but
47:09that's the design. Your formula to
47:11memorize. Volume times drop factor over
47:15time in minutes. Remember, mini drip is
47:1960 drops per milliliter. Mini or micro
47:22is 60. macro is 10 or 20 or 15 or 12,
47:28but boards will say it's 10, which is
47:32really stupid because all manufacturers
47:34are different. Micro and MIDI are always
47:3760. 60 drops per milliliter. That's your
47:41drop factor. The next two are podiatric
47:44dose questions where you're using the
47:46child's weight in pounds. They will give
47:49you these. It's 2.2 2 lb per kilog. They
47:53will always give you the kilogram
47:55weight. They always give you pounds and
47:57ask for kilog. So, you're going to be
47:59dividing pounds by 2.2. You will always
48:03be dividing by 2.2.
48:05You will never be multiplying by it. So,
48:07take the weight, divide by 2.2, then do
48:11your math and pay attention to whether
48:13they're asking the total amount per day
48:15for the amount to be given or just at
48:18one time. Before we move ahead, let me
48:20take a quick moment to tell you
48:22something that could completely change
48:24your ENLEX journey. If you're serious
48:27about passing the ENCLEX in just one
48:28week or even within a month, then the
48:30smartest move you can make right now is
48:32to enroll in our complete online ENLEX
48:35crash course. This isn't just another
48:36course. It's a shortcut, a clear
48:37step-by-step road map that has already
48:39helped over 100,000 nursing students
48:41pass the ENCLEX with confidence. And
48:42here's the most incredible part. Not a
48:44single student who completed this course
48:46has failed. Yes, that's a 100% passing
48:49rate. We built this course based
48:51entirely on the feedback and insights of
48:52thousands of nurses who've successfully
48:54cleared the enollex in the last 5 years.
48:56That means we've removed all the fluff
48:58and focused only on what truly matters
48:59for your exam. Here's exactly what
49:01you'll get when you enroll. You'll get
49:02100 hours of animated crash course
49:04content designed for rapid revision, 500
49:06hours of comprehensive recorded lectures
49:08covering all the high yield topics, and
49:10access to 10,000 real and clelex
49:12questions to sharpen your test taking
49:14skills. You'll also get 500 nextgen
49:15case-based questions to strengthen your
49:17clinical judgment along with 15
49:19full-length practice tests that simulate
49:21the real ENLEX experience. And of
49:23course, you'll receive our complete
49:24Enclelex ebook and PDF notes, plus one
49:27full year of access so you can study at
49:28your pace on your schedule. And yes,
49:30we're currently offering a 70% discount
49:32for a very short period. Once the offer
49:34ends, it's gone. Thousands of students
49:35are enrolling in our online ENLEX course
49:37every month and passing the exam. But if
49:39you don't enroll now, you risk being
49:41left behind. Spots are filling fast and
49:43only a few seats are left. Visit our
49:44website to enroll now. Link is given in
49:46description box. Let's continue the
49:48video. First lecture is about acid and
49:51base imbalances and ventilator settings.
49:55First we will read acid base balance
49:58here. If they give you lab values, you
50:02have to convert it to words. Step one is
50:06to memorize these lab values
50:09first. like pH, carbon dioxide and
50:12bicarbonate. You should know what the
50:15normal values are. Then step two is
50:18looking at the pH value first and see if
50:22it is acidosis or alkyossis.
50:26Normal pH value is 7.35
50:30to 7.45.
50:33If it is less than 7.34,
50:36it's acidosis. If it is higher than
50:397.45,
50:41it is alkalossis.
50:43And then step three, you should use the
50:46rule of bees. The rule of bees is when
50:49the pH and the bicarb are both in the
50:53same direction, it's metabolic. BBB.
50:57And on the other hand, if pH and the CO2
51:01are in opposite directions, it's
51:04respiratory.
51:05Does that make sense? So again, this
51:09diagram shows it in a little simpler
51:11way. You first look at the pH value and
51:15identify if it's acidosis or alkalossis
51:19based on the pH value. Then you compare
51:22the trend of pH with by carb and look to
51:25see if both are in the same direction.
51:28If they are, then it's metabolic. If
51:31not, you look at the trend of pH and
51:34compare it with the carbon dioxide.
51:37If they are in opposite direction, it's
51:39respiratory.
51:41Here at the bottom shows the memory
51:43trick for acid base imbalances rule of
51:46bees that tells you when pH and by carb
51:50are both in the same direction, it's
51:52metabolic. And remember the acronym
51:55roam. Respiratory is opposite and
52:00metabolic is equal. So let's look at how
52:05this rule would work by solving some of
52:08the example questions here. First we
52:11have to know the normal values. What's
52:14the normal pH value? It's 7.35
52:18to 7.45.
52:20Normal bicarbonate level is 22 to 26.
52:26Also you could remember it as 2 + 2 + 2
52:31is equal to 6.
52:33again 22 and 26 for by carb based on the
52:38normal values that we memorized.
52:41Let's look at our examples. First
52:44example, the pH is 7.3
52:48which is lower than the normal range of
52:507.35 to 7.45.
52:53So it's acidosis. And now you look at by
52:56carb and see where it sits. by carbs
52:59normal range is 22 to 26.
53:03Remember the 22 to 26 and the by carb of
53:0720 is lower than the normal range. So pH
53:10and by carb are both in the same
53:12direction of down. So it's metabolic.
53:16So the first example is metabolic
53:19acidosis.
53:21Let's look at the second example. The pH
53:24is 7.58
53:26which is higher than the normal range of
53:287.35 to 7.45.
53:32So it's alkalossis. And now you look at
53:34by carb and see where it sits. Bicarb's
53:38normal range is 22 to 26. Again the 22
53:42to 26 is the by carb and the barb of 32
53:46is higher than the normal range. PH and
53:50by carb both in the same direction of
53:52up. So, it's metabolic. The second
53:55example is metabolic alkyossis. Boards
53:59don't question you about mixed and
54:01complicated imbalances like compensated,
54:04uncompensated, and fully compensated
54:06stuff usually, but for your information,
54:09I'm going to briefly cover the
54:11differences between fully, partially,
54:14and uncompensated imbalances.
54:17If pH is normal and there is either
54:19acidosis or alkyossis, it's a fully
54:23compensated imbalance.
54:25If one of either CO2 or by carb is
54:29normal, it's an uncompensated imbalance.
54:33And if all these values, pH, CO2, and by
54:38carb are all abnormal, meaning if they
54:41are all out of the normal range, it's a
54:44partially compensated imbalance.
54:47All right, that's it about the ABG
54:51interpretation.
54:53Let's talk about signs and symptoms of
54:56acid and base imbalances.
54:58The type of question the board likes to
55:00ask about usually is in a select all
55:03that apply SATA format. What they like
55:08to do is that they will throw out a lot
55:10of signs and symptoms of disease and
55:13disorder and let you select everything
55:16that is related to that disease or
55:18disorder. In this type of question, it
55:21is important to know the trend because
55:23you can't remember all of them, but you
55:26should know the trend of those cohesive
55:29characteristics and you should be able
55:31to pick and choose the correct
55:33sentences.
55:35So what they will do is for example they
55:38will tell you that a patient has
55:39respiratory acidosis
55:41metabolic alkalossis or something like
55:44that and they'll say what you would see
55:47in the situation and select all that
55:50apply and you get a whole list of
55:52options. You have to check check and
55:56check but the thing is how will you
55:59memorize all the lists for each disease
56:02and disorder? It's nearly impossible.
56:06For example, if I learned 10 signs and
56:10symptoms of hypercalcemia
56:12and then 10 signs and symptoms of
56:14hypocalcemia and when I took the test,
56:18guess what would happen? I've memorized
56:21how I would remember the lists word for
56:24word and I could reproduce the list, but
56:27I forgot which one was which. So the
56:30point is this board does not test your
56:33knowledge of lists.
56:35What the board tests is your knowledge
56:38of principles not lists.
56:42But how will they test it? Boards will
56:45not test your knowledge of lists. They
56:48will test your knowledge of principles
56:50by having you generate lists. So, it's
56:54better to know the general path of
56:56physiology and trend than memorizing
56:59every single list word for word because
57:02on the board they will rephrase them.
57:05For example, in general, what does pain
57:08medicine do in general? What do pain
57:11opiate medications do? Do they sedate
57:15your central nervous system?
57:17Okay. Now they will ask a question like
57:21your patient is on morphine which is an
57:23opioid analesic.
57:26What are the following things that you
57:28would expect to see if they got too much
57:30of that?
57:32And are you thinking, "Oh my god, I
57:34don't remember the list." But it's not
57:36about memorizing the signs and symptoms
57:39of morphine overdose. It's to see if you
57:42know that opiate anesics as a depressive
57:45agent and picking all the symptoms that
57:48correlate to depressive characteristics.
57:51Okay, back to the acid base imbalances.
57:55You are applying the same principle
57:57here. We should be able to generate the
58:00list ourselves. But first, you should
58:03remember as pH goes up so does my
58:06patient.
58:08What does that mean? As the pH goes up,
58:11the patient goes up. As pH goes down, so
58:15does the patient. So, the patient goes
58:18down as well. What it means is that when
58:21the pH goes up, every system in your
58:24body gets more irritable. But when your
58:28pH goes down, systems in your body shut
58:31down and things go down as well. Again,
58:34when your patient goes down, you shut
58:36down. When your patient is up,
58:39everything gets hyperexitable.
58:42It's pure chemistry.
58:44Basically, the catalyzing chemical
58:46reactions. But remember, this is all
58:50except for potassium.
58:53So, what does that mean? If you have
58:56alkalossis, it means your pH value is
58:59higher than the normal range, bigger
59:01than 7.45.
59:04As pH goes up, so does the patient.
59:07But potassium goes down. The signs and
59:11symptoms that you will see in alkalossis
59:14are hyper irerritated body status and
59:17hypocalemia.
59:19So how would heart rate go to
59:20tachicardia?
59:22How about respiratory rate? It will be
59:25tachypnia.
59:27Blood pressure it will be hypertension.
59:30Cnswise hyper irritable which can make
59:34you seizure. Muscle wise, what about
59:37your bowels? Diarrhea and babbory, which
59:41is increased bowel sounds. What about
59:44reflex hyper reflexia? So + three and
59:48plus4.
59:50But remember your potassium is opposite
59:53to pH. So high pH means low potassium.
59:57So hypoc calmia.
1:00:00Okay. And if your patient is hyper
1:00:02irritable, your patient is at risk for
1:00:05seizure and aspiration in the worst case
1:00:08scenario. So as a nurse, you want to
1:00:11make sure there is suction available at
1:00:13the bedside as a safety check. Does that
1:00:16make sense? So here we generated all
1:00:20these lists based on what we know about
1:00:23the relationship between pH and the
1:00:25physiological status. Again, as pH goes
1:00:28up, so does your patient, but for
1:00:32potassium. And with this sentence, you
1:00:35can generate all these lists without
1:00:38even memorizing them word for word. And
1:00:41you can assume that there is risk for
1:00:43seizure and that the nurse should ensure
1:00:45there is suction available for the
1:00:47worstc case scenario.
1:00:50Don't limit yourself when they start
1:00:52asking these things. You should be like,
1:00:55"Wait a minute. I know about this. I can
1:00:58get there." Okay. Now, what about
1:01:02acidosis? It's the same analogy. Just
1:01:05remember this sentence here. When pH is
1:01:08low, everything is low except potassium.
1:01:12So, if you have acidosis, it means your
1:01:15pH value is lower than the normal range,
1:01:18smaller than 7.35.
1:01:21As pH goes down, so does the patient but
1:01:25potassium is high. So the signs and
1:01:28symptoms that you will see in acidosis
1:01:31are hypoactive body status, hyperglemia,
1:01:35bradic cardia, hypotension,
1:01:38bradypnia,
1:01:40lethargic and uptunded flaccid and
1:01:43hypoactive bowel sounds. What about
1:01:46reflexes?
1:01:47Hyper reflexia. So 0 and + one because
1:01:52normal reflex is +2. But remember your
1:01:56potassium is opposite to pH. So low pH
1:01:59means high potassium. So it's hyperc
1:02:02calmia.
1:02:04Okay. And if your patient is
1:02:06hypoarritable, the patient is at risk
1:02:09for respiratory arrest in the worst case
1:02:11scenario. As a nurse, you want to make
1:02:14sure there is an amboo bag or intubation
1:02:17and ventilation available at the
1:02:19bedside. Remember, if things are hyper
1:02:23and the hyper patient can seizure,
1:02:25things will go down and the patient will
1:02:27go down and can end up in a coma or in
1:02:30respiratory arrest. Seizure is when
1:02:33things are up and coma is when things
1:02:36are down. They go the same as the pH.
1:02:39Again here we generated all these lists
1:02:43again based on what we know about the
1:02:45relationship between pH and the
1:02:48physiological status. You should be able
1:02:51to get to all this list by thinking
1:02:53about the general principle of pH
1:02:56related symptoms.
1:02:58And a quick memory trick here when one
1:03:01of the lists is cosm respiration which
1:03:04is deep and labored breathing pattern.
1:03:07Now let's look at this example. What are
1:03:10the signs and symptoms of respiratory
1:03:13acidosis?
1:03:14Select all that apply.
1:03:17So what do we say for signs and symptoms
1:03:20of acid and base imbalances?
1:03:22You should look at the trend of pH. Does
1:03:25pH go up or does it go down? It's
1:03:29acidosis. So pH is less than 7.35.
1:03:34The pH is down again. Where the pH goes,
1:03:37so does the patient except for
1:03:39potassium. So acidosis is lower pH. So
1:03:43the patient goes down. Let's look at the
1:03:46list here.
1:03:48Reflexes patient goes down. So hypo
1:03:52reflexia. Therefore plus one or zero
1:03:56reflex.
1:03:57How about their bowel? Patient goes
1:04:00down. So hypoactive bowel sounds.
1:04:04What about their urine? Patient goes
1:04:07down. So hypoactive urine output meaning
1:04:12urinary retention. What about the heart
1:04:14rhythm? The patient goes down. So heart
1:04:17rate will also go down. Therefore, heart
1:04:20block can happen and brady cardia can
1:04:23happen as well. What about potassium?
1:04:27The patient goes down. But remember
1:04:29potassium is the opposite. So potassium
1:04:32is going to go up. Therefore hyperc
1:04:35calmia not hypoc calmia. Okay. Now let's
1:04:40look at the causes of acid and base
1:04:43imbalances.
1:04:45It's different from signs and symptoms
1:04:47of acid and base imbalances. They may
1:04:50look similar, but you have to know the
1:04:52differences, and you should be able to
1:04:54pick the correct choice for select all
1:04:57that apply questions.
1:04:59First, be sure to look and see if the
1:05:02question is asking about the signs and
1:05:04symptoms or causes of the acid and base
1:05:08imbalances. The first thing to look at
1:05:10when it comes to the causes of acid or
1:05:12base imbalances is when it is
1:05:15respiratory. It means things are related
1:05:18to the lungs. When it says respiratory
1:05:21acidosis or respiratory alkyossis, you
1:05:24should say, "Oh, it's the lungs that's
1:05:27causing this imbalance." And then you
1:05:30should ask yourself, are they
1:05:32overventilating or under ventilating? If
1:05:36it's underventilating, meaning things go
1:05:38down, therefore the patient goes down
1:05:41when pH goes down. So in other words, pH
1:05:45is less than 7.35
1:05:48which means acidosis.
1:05:50Does that make sense?
1:05:52So when it's underventilating things go
1:05:55under. So pH is under the normal range.
1:06:00So acidosis
1:06:03if they are over ventilating then things
1:06:06go over and the pH goes over the normal
1:06:10range which means alkyossis.
1:06:13Let's look at some examples and see what
1:06:15kind of acid and base imbalances are
1:06:18present in each example. First, when you
1:06:22are in labor, what would you have for
1:06:24acid and base imbalance?
1:06:26You're thinking about the physiological
1:06:29process here. If the mother is in labor,
1:06:32they are having a hard time breathing
1:06:34because of pain and all of that which
1:06:37will make her hyperventilate.
1:06:39Overvententilate breathing means the
1:06:41lungs which means respiratory imbalance
1:06:44and overventilating means a higher pH
1:06:47value so alkalossis.
1:06:50So they have respiratory alkyossis.
1:06:55Let's look at the second example. What
1:06:57about a drowning person? When they are
1:07:00drowning, how would their breathing look
1:07:02like? They can't breathe in a drowning
1:07:05situation. So they are hypoventilating
1:07:09like underventilating.
1:07:11This means their pH would also go down.
1:07:14So it's acidosis
1:07:16and it's also related to breathing like
1:07:19lungs. So it's a respiratory problem. So
1:07:22they have respiratory acidosis.
1:07:26Okay. What about a patient with a PCA?
1:07:30The PCA pump has analesics like pain
1:07:33medication in there and that makes
1:07:35things go down because they are CNS
1:07:38depressants. So that will lead to point
1:07:41to go down and their respiratory would
1:07:44be under ventilating meaning the pH will
1:07:47go down as well. So respiratory acidosis
1:07:51presents in this condition.
1:07:54What if it's not related to lungs? It's
1:07:58going to be metabolic imbalances then.
1:08:01So how do you know if they are alkyossis
1:08:04or acidosis?
1:08:06You just need to memorize one thing.
1:08:10If the patient has been vomiting or been
1:08:12suctioning, meaning their acid is in
1:08:15their GI tract, it is being taken out of
1:08:18their body, meaning their acidity in the
1:08:21body goes down, meaning they became
1:08:25alkyossis.
1:08:26And because there is no lungs or
1:08:28respiratory things involved here, it is
1:08:31metabolic.
1:08:33In such cases like emmesis or vomit or
1:08:37suction, you should pick metabolic
1:08:39alkyossis.
1:08:41But for everything else that is not
1:08:43related to the lungs, you pick metabolic
1:08:46acidosis.
1:08:48For enclelex, when you don't know what
1:08:51imbalance it is and it's not related to
1:08:54the lungs and it's not vomit or suction,
1:08:57your default answer should be metabolic
1:09:00acidosis.
1:09:02Now, what about this person who has
1:09:04acute renal failure? What acidbased
1:09:07disorder does she have? Metabolic
1:09:11acidosis. Before we move ahead, let me
1:09:13take a quick moment to tell you
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1:10:16you'll receive our complete Enclelex
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1:10:39description box. Let's continue the
1:10:40video. Let's talk about ventilators.
1:10:44Now, a ventilator is a machine that is
1:10:47designed to move breathable air in and
1:10:50out of the lungs to help patients who
1:10:53are physically unable to breathe or
1:10:55breathe sufficiently. And there are two
1:10:58alarms that you can hear from the
1:10:59ventilators when you work on the ICU.
1:11:03So there are two types of ventilator
1:11:05alarms, high pressure and low pressure
1:11:08alarms.
1:11:09First is the high-pressure alarm. When
1:11:13does a highpress alarm go off? High
1:11:16pressure alarms are triggered by
1:11:18increased resistance to air flow. So
1:11:21resistance that is due to any
1:11:23obstruction that makes the alarm to beep
1:11:25at a high-pitched sound. For example,
1:11:29when the tubing of the ventilator is
1:11:31kinkedked, it creates obstruction to the
1:11:33airway and creates the resistance there
1:11:36and leads to the high-pressure alarm.
1:11:39When the water in the dependent tube is
1:11:41condensed, the tube is obstructed with
1:11:44water and creates resistance here again
1:11:46and creates the high-pressure alarm.
1:11:50When the patient has mucus plugs, the
1:11:52airway is obstructed and that leads to
1:11:54resistance for airway flow and creates
1:11:57the high-pressure alarm sound as well.
1:12:00So, what should you do in each
1:12:03situation?
1:12:05When the tube is kinkedked, you simply
1:12:07uncink it. When the water is condensed
1:12:10in the dependent tube, you simply just
1:12:13empty the water. When the patient has
1:12:16mucus plugs, make the patient to turn
1:12:18and cough and take a deep breath or
1:12:22suction them to get rid of the plugs
1:12:24that were causing the resistance and
1:12:26obstruction.
1:12:27When all of these are suspected, what is
1:12:30the correct order for you to take?
1:12:33Stop the high-pressure alarm. Then first
1:12:36unc
1:12:41lastly do the suction. What about the
1:12:44low pressure alarm?
1:12:47Its cause is the opposite of the high
1:12:49pressure alarm. The low pressure alarm
1:12:52is triggered by decreased resistance to
1:12:54air flow. So when things are
1:12:56disconnected, you lose the resistance
1:12:59and that creates the low pressure alarm.
1:13:02So in such situations you should look
1:13:05for a disconnection.
1:13:07There are two things that can be
1:13:09disconnected.
1:13:10First is the main tube and the second is
1:13:14the oxygen sensor tube. When either of
1:13:17these are disconnected and you hear the
1:13:19low pressure alarm sound, just simply
1:13:22reconnect them to regain the proper
1:13:24resistance to air flow.
1:13:27The ventilator has to be set to the
1:13:29patient with the appropriate settings
1:13:32for having too much ventilation or too
1:13:34little ventilation can lead to acid base
1:13:37imbalances again. So when the ventilator
1:13:40setting is too high the patient will be
1:13:42overventilated
1:13:44meaning they are going to have
1:13:46respiratory imbalance and because the
1:13:48patient goes up with the over
1:13:50ventilation the pH will go up as well
1:13:54meaning alkyossis.
1:13:57So this patient will be panting with
1:13:59respiratory alkalossis.
1:14:02What if the ventilator setting is too
1:14:05low? The patient will be underventilated
1:14:08meaning they are going to have
1:14:10respiratory imbalance again but because
1:14:12the patient goes down with the
1:14:14undervententilation the pH will go down
1:14:17as well meaning they will become
1:14:19acidotic. So this patient will end up
1:14:22retaining carbon dioxide due to
1:14:24respiratory acidosis.
1:14:27Let's go over this question here as a
1:14:29recap for acid base imbalances and the
1:14:32ventilator system. So the question is
1:14:36the physician wants the impatient off
1:14:38the ventilator at 6:00 in the morning
1:14:40and the AG result says that the patient
1:14:43has respiratory acidosis.
1:14:46What would you do next as a nurse?
1:14:49Okay. So weaning off the ventilator
1:14:52means the patient can ventilate
1:14:54themselves without the vent support. In
1:14:57order to see if the patient is ready for
1:14:59winning or not, you should look at the
1:15:02acid base gases lab result. The result
1:15:06said that the patient has respiratory
1:15:08acidosis,
1:15:10meaning the lungs are ventilating but pH
1:15:13is low. So the patient is
1:15:15underventilating.
1:15:17That means that the patient is not ready
1:15:19for weaning off the ventilator just yet.
1:15:22So what should you do as the nurse?
1:15:26You should notify the doctor that the
1:15:28patient is not ready to be weaned off
1:15:30the ventilator.
1:15:32Based on the AG lab result, the patient
1:15:34will be ready to be weaned off when they
1:15:37are over ventilating which will be shown
1:15:39as respiratory alkalossis on the ABG
1:15:43result. I hope this video helped you
1:15:46with studying for your enclelex. If you
1:15:49found the video helpful, please give it
1:15:51a thumbs up and don't forget to
1:15:53subscribe to the channel so that you
1:15:55don't miss any important nursing
1:15:57lectures. Before we move ahead, let me
1:15:59take a quick moment to tell you
1:16:01something that could completely change
1:16:03your ENCLEX journey. If you're serious
1:16:05about passing the ENLEX in just one week
1:16:07or even within a month, then the
1:16:09smartest move you can make right now is
1:16:11to enroll in our complete online
1:16:13enclelex crash course. This isn't just
1:16:15another course. It's a shortcut, a clear
1:16:16step-by-step road map that has already
1:16:18helped over 100,000 nursing students
1:16:20pass the ANCLEX with confidence. And
1:16:21here's the most incredible part. Not a
1:16:23single student who completed this course
1:16:25has failed. Yes, that's a 100% passing
1:16:28rate. We built this course based
1:16:30entirely on the feedback and insights of
1:16:31thousands of nurses who've successfully
1:16:33cleared the ENCLEs in the last 5 years.
1:16:35That means we've removed all the fluff
1:16:37and focused only on what truly matters
1:16:38for your exam. Here's exactly what
1:16:40you'll get when you enroll. You'll get
1:16:41100 hours of animated crash course
1:16:43content designed for rapid revision. 500
1:16:45hours of comprehensive recorded lectures
1:16:47covering all the high yield topics and
1:16:49access to 10,000 real enclelex questions
1:16:51to sharpen your test taking skills.
1:16:53You'll also get 500 nextgen case-based
1:16:55questions to strengthen your clinical
1:16:56judgment along with 15 fulllength
1:16:58practice tests that simulate the real
1:17:00enclelex experience. And of course,
1:17:02you'll receive our complete enclelex
1:17:04ebook and PDF notes, plus one full year
1:17:06of access so you can study at your pace
1:17:08on your schedule. And yes, we're
1:17:09currently offering a 70% discount for a
1:17:11very short period. Once the offer ends,
1:17:13it's gone. Thousands of students are
1:17:15enrolling in our online enclelex course
1:17:16every month and passing the exam. But if
1:17:18you don't enroll now, you risk being
1:17:20left behind. Spots are filling fast and
1:17:22only a few seats are left. Visit our
1:17:23website to enroll now. Link is given in
1:17:25description box. Let's continue the
1:17:27video. Before we move ahead, let me take
1:17:28a quick moment to tell you something
1:17:30that could completely change your
1:17:32enclelex journey. If you're serious
1:17:34about passing the enclelex in just one
1:17:36week or even within a month, then the
1:17:38smartest move you can make right now is
1:17:40to enroll in our complete online
1:17:42enclelex crash course. This isn't just
1:17:43another course. It's a shortcut. A clear
1:17:45step-by-step road map that has already
1:17:47helped over 100,000 nursing students
1:17:49pass the ANCLEX with confidence. And
1:17:50here's the most incredible part. Not a
1:17:52single student who completed this course
1:17:54has failed. Yes, that's a 100% passing
1:17:57rate. We built this course based
1:17:58entirely on the feedback and insights of
1:18:00thousands of nurses who've successfully
1:18:02cleared the ENCLEs in the last 5 years.
1:18:04That means we've removed all the fluff
1:18:05and focused only on what truly matters
1:18:07for your exam. Here's exactly what
1:18:08you'll get when you enroll. You'll get
1:18:10100 hours of animated crash course
1:18:12content designed for rapid revision, 500
1:18:14hours of comprehensive recorded lectures
1:18:16covering all the high yield topics, and
1:18:18access to 10,000 real Enclelex questions
1:18:20to sharpen your test taking skills.
1:18:22You'll also get 500 NextGen case-based
1:18:24questions to strengthen your clinical
1:18:25judgment along with 15 fulllength
1:18:27practice tests that simulate the real
1:18:29enclelex experience. And of course,
1:18:31you'll receive our complete enclelex
1:18:33ebook and PDF notes, plus one full year
1:18:35of access so you can study at your pace
1:18:37on your schedule. And yes, we're
1:18:38currently offering a 70% discount for a
1:18:40very short period. Once the offer ends,
1:18:42it's gone. Thousands of students are
1:18:43enrolling in our online enclelex course
1:18:45every month and passing the exam. But if
1:18:47you don't enroll now, you risk being
1:18:49left behind. Spots are filling fast and
1:18:50only a few seats are left. Visit our
1:18:52website to enroll now. Link is given in
1:18:54description box. Let's continue the
1:18:55video. Let's discuss a most important
1:18:58topic, diabetes. Diabetes is a disorder
1:19:02related to glucose metabolism. In
1:19:05simpler terms, people with diabetes have
1:19:07difficulty processing glucose. This can
1:19:09be due to a lack of insulin or because
1:19:12cells have become resistant to insulin.
1:19:14Since glucose is a primary fuel source
1:19:16for our body, those with diabetes face
1:19:19challenges. Their bodies cannot
1:19:21effectively use this essential fuel and
1:19:24as a result cells can die making the
1:19:27disease severe. Diabetes incipitus
1:19:30versus diabetes mellus. It's crucial not
1:19:33to confuse diabetes melllois with
1:19:35diabetes incipitus. They are not the
1:19:38same. Diabetes incipitus it results in
1:19:41increased thirst polyypipssia and
1:19:44increased urine production polyura
1:19:47leading to dehydration. This is due to a
1:19:50lack of the hormone ADH. So when
1:19:53thinking of diabetes and cypitus
1:19:55remember these symptoms polyura,
1:19:58polyypipssia and dehydration. They
1:20:00resemble symptoms of diabetes melloadus
1:20:02which also includes polyora and
1:20:05polyypipssia. However, with diabetes
1:20:07incipitus, it's only about the fluid
1:20:10imbalance, not the glucose. Therefore,
1:20:12if asked about urine output in diabetes
1:20:15incipitus, it's high. S I Ah, syndrome
1:20:19of inappropriate antidiuretic hormone.
1:20:22This is the opposite of diabetes
1:20:25incipitus. Instead of remembering every
1:20:27detail about SI ADH and diabetes
1:20:30incipitus, consider this. We know
1:20:32diabetes melodis leads to polyura and
1:20:35polyypipssia. Hence, diabetes incipitus
1:20:38also has polyura and polyypipssia. On
1:20:40the other hand, siadh is the opposite
1:20:43leading to reduced urine output,
1:20:46oligura, and a lack of thirst due to
1:20:49water retention. Consequently, while
1:20:51those with diabetes incipitus and
1:20:52diabetes mellous lose water and weight,
1:20:56those with si ah gain weight due to
1:20:59water retention, urine output and blood
1:21:02glucose relationships. A person with a
1:21:04urine output of 200 ml per hour over 3
1:21:08hours and normal blood glucose might
1:21:10have diabetes symptoms. If another
1:21:12person has the same urine output but a
1:21:14glucose level of 280. If someone
1:21:17excretes 10 cc's of urine in 3 hours
1:21:20with normal blood glucose, it suggests
1:21:23SIADH. Diabetes conditions show similar
1:21:26urine outputs. While SIADH exhibits the
1:21:29opposite urine output pattern.
1:21:31Relationship between urine volume and
1:21:33specific gravity. It's inverse. Lower
1:21:36urine output leads to higher specific
1:21:38gravity and vice versa. SIADH would have
1:21:42high specific gravity due to reduced
1:21:44urine output. Diabetes incipitus would
1:21:47have a high urine output implying a low
1:21:49specific gravity. Nursing diagnosises
1:21:52fluid volume deficit. This indicates
1:21:55higher urine output associated with DM
1:21:57and DI. Fluid volume excess. Think about
1:22:00which condition would result in an
1:22:02accumulation of fluid. That is SIADH.
1:22:06Diabetes mellous overview. Type 1
1:22:09diabetes. Other names are insulin
1:22:11dependent diabetes melodis, IDM,
1:22:14juvenile onset or ketosisprone diabetes
1:22:19melloadus, type 2 diabetes. Other names
1:22:22are non-inssulin dependent diabetes
1:22:24melodous ndm
1:22:27non- ketosisprone or adult onset
1:22:30diabetes mellus. Symptoms of diabetes.
1:22:33The three Ps to remember. Polyura,
1:22:36excessive urination. Polyypipssia,
1:22:38excessive thirst. Polyphasia,
1:22:41technically it means increased
1:22:42swallowing. However, in the context of
1:22:44diabetes, it refers to an increased
1:22:47appetite. Treatment of type 1 diabetes.
1:22:49The three main treatments are diet. This
1:22:53is less rigid now. Patients are
1:22:55generally allowed to eat what they want
1:22:57with some guidance. Insulin, the most
1:22:59crucial treatment for type 1 diabetes,
1:23:02and exercise, an essential component for
1:23:05managing diabetes. Now, we will be
1:23:07discussing diabetes management, focusing
1:23:09on dietary interventions. It's essential
1:23:12to understand the nuances between type 1
1:23:14and type 2 diabetes, especially in terms
1:23:17of dietary adjustments. Firstly,
1:23:20individuals with type 1 diabetes, they
1:23:22count their carbs and adjust their
1:23:24insulin doses accordingly based on their
1:23:27blood sugar level checked by glucose
1:23:28meters. We've evolved in our approach.
1:23:31Previously, we significantly restricted
1:23:34their diets. However, nowadays, while we
1:23:36advise against consuming a lot of
1:23:38refined carbohydrates like pure sugars,
1:23:41they can still consume these, but they
1:23:43must adjust their insulin doses
1:23:45accordingly. On the other hand, type 2
1:23:47diabetes is different. If untreated,
1:23:50type 2 diabetes leads to DOA. Here, DOA
1:23:53stands for diet, oral hypoglycemics, and
1:23:57activity. All right, let's delve deeper
1:24:00into the dietary component, primarily
1:24:02focusing on type 2 diabetes. The most
1:24:04important aspect of a diabetic diet for
1:24:07type 2 patients is calorie restriction.
1:24:09That's why we have diets named after
1:24:11calorie counts like the 1,200 calorie or
1:24:14the 800 calorie ADA diet. Calorie intake
1:24:18matters. Another significant dietary
1:24:20recommendation is to divide the daily
1:24:22calorie intake into six small meals.
1:24:25Why? Because this prevents sudden spikes
1:24:28in blood sugar levels. Think about it.
1:24:30Consuming all your daily calories in
1:24:32just three meals could cause massive
1:24:35blood sugar peaks, but splitting them
1:24:37into six meals would ensure a more
1:24:39stable blood sugar level. Remember, on
1:24:41your exams and in real life scenarios,
1:24:44it's crucial to differentiate between
1:24:47first and best actions. While it might
1:24:50be best in the long run, to strictly
1:24:52limit calorie intake, the first step,
1:24:55especially for someone consuming a large
1:24:57number of calories daily, might be to
1:24:59teach them meal splitting. Let's dive
1:25:01into function of insulin. Insulin's
1:25:04primary role is to regulate blood
1:25:06glucose levels because it lowers blood
1:25:09glucose. There are multiple types of
1:25:10insulin. Regular insulin, it's
1:25:12recognizable by the bold letter R on its
1:25:15packaging, regardless of its brand name.
1:25:18This is commonly known as short rapid
1:25:20acting insulin. It has an onset of 1
1:25:23hour, peak of 2 hours, and a duration of
1:25:264 hours. Regular insulin is clear in
1:25:29appearance. It's also suitable for IV
1:25:31drips. NPH insulin denoted by the letter
1:25:34N. This is truly an intermediate acting
1:25:37insulin onset of 6 hours, peak of 8 to
1:25:4010 hours, and a duration of 12 hours. N
1:25:43PH insulin is cloudy in appearance and
1:25:46is intermediate acting due to its
1:25:48suspension nature. It's not suitable for
1:25:51IV drips. Lispro Humalogue. This is the
1:25:54world's fastest acting insulin onset of
1:25:5615 minutes, peak of 30 minutes and a
1:25:59duration of 3 hours. Given its rapid
1:26:01action, it's administered during meals.
1:26:03Glargine Lantis, a long acting insulin
1:26:06absorbs so slowly that it doesn't
1:26:08essentially peak, posing little to no
1:26:11risk of hypoglycemia. It has a duration
1:26:13of 12 to 24 hours. This is the only
1:26:16insulin that's safe to be given at
1:26:18bedtime. A monomic that might help you
1:26:20remember. For regular and NPH, just
1:26:22remember the sequence 1 2 4 and 6 8 10
1:26:2812 respectively. It corresponds to their
1:26:30onset, peak, and duration. Now focusing
1:26:33on practical aspects, always remember to
1:26:36check the expiration date on insulin
1:26:38vials and mark the date when you open an
1:26:41insulin vial as the manufacturer's
1:26:43expiration date becomes void once
1:26:45opened. The new expiration date becomes
1:26:4730 days post opening. How to mix and
1:26:50draw insulin using a single syringe.
1:26:53Before drawing up the insulin, inject
1:26:55air equal to the dose of insulin you'll
1:26:58be taking into the vials. First, inject
1:27:00air into the NPH vial, followed by the
1:27:03regular vial. Always draw up the regular
1:27:06clear insulin first and then the NPH or
1:27:10cloudy insulin. This sequence ensures
1:27:12that the regular insulin isn't
1:27:14contaminated by the NPH insulin. Decide
1:27:17on your injection site. Common areas
1:27:19include the upper arm, thigh, buttocks,
1:27:22and abdomen. It's essential to rotate
1:27:24your injection sites to prevent
1:27:26lipodistrophe, which is a lump under the
1:27:28skin resulting from the accumulation of
1:27:31extra fat. Always store unopened insulin
1:27:34vials in the refrigerator. Opened vials
1:27:36can be kept at room temperature.
1:27:38Remember, never freeze insulin. Let's
1:27:41think of exercise as an additional shot
1:27:43of insulin. When someone exercises, it's
1:27:46as if they're receiving another dose of
1:27:48insulin. For example, if someone says,
1:27:50"I have gym class this morning." Think
1:27:52of it as I'm getting an extra shot of
1:27:55insulin this morning. Consequently, if
1:27:57you're more active, you'll need less
1:27:59insulin. However, if you're less active,
1:28:02you'll need more. Take the scenario as
1:28:03an example. If a diabetic student plans
1:28:06to play soccer in the afternoon, what
1:28:08should the school nurse recommend? Given
1:28:10that exercise acts like an additional
1:28:12shot of insulin, the student should have
1:28:14some rapidly metabolizable carbohydrates
1:28:16as a snack before and during the game.
1:28:19Dealing with illness in diabetics.
1:28:21Diabetics can get sick for various
1:28:23reasons like anybody else. When sick,
1:28:26their glucose levels tend to rise. So,
1:28:29even if they aren't eating, they must
1:28:30take their insulin. Being sick stresses
1:28:33the body, causing a rise in glucose
1:28:35levels. Thus, sick diabetics should
1:28:38continue taking their insulin, take sips
1:28:40of water to avoid dehydration, and stay
1:28:42as active as possible to help lower
1:28:44glucose levels. Complications of
1:28:47diabetes, hypoglycemia, low blood sugar.
1:28:50Causes: Taking too much diabetes
1:28:52medicine, not eating enough food, or
1:28:54doing too much exercise. Signs: They act
1:28:57like they're drunk and in shock, shaky,
1:29:00confused, might be sweaty, and could be
1:29:02irritable. Solution: Give them something
1:29:04sugary, like juice or candy. If they're
1:29:07unconscious, they need medical attention
1:29:09immediately. Another complication is
1:29:11diabetic ketoacidosis,
1:29:13DKA. What is it? It's a severe problem
1:29:16where there's too much sugar and acid in
1:29:18the blood. Who gets it? Mostly people
1:29:20with type 1 diabetes. Causes. The main
1:29:23cause can be getting sick like catching
1:29:25a cold or flu. But not taking enough
1:29:28diabetes medicine, eating too much food
1:29:30or not exercising enough can contribute
1:29:33signs. They are dehydrated, breathe
1:29:36deeply and quickly, have a fruity smell
1:29:38to their breath, and may be very sleepy.
1:29:41Now, let's delve into the topic of
1:29:43diabetic ketoacidosis,
1:29:45often abbreviated as DKA. If someone has
1:29:48ketones in their urine, does it
1:29:50necessarily mean that they have diabetic
1:29:53ketoacidosis? No, it doesn't. A person
1:29:55can have ketones present in their urine
1:29:58and still not have diabetic keto
1:30:00acidosis. However, if you find ketones
1:30:02in the blood, that confirms diabetic
1:30:05keto acidosis. Thus, it's the presence
1:30:08of ketones in the blood, not the urine,
1:30:11that verifies the diagnosis. Now, when
1:30:14we look into diabetic ketoacidosis,
1:30:16there are three main things that stand
1:30:18out represented by the three Ks. One,
1:30:22the first K refers to ketones present in
1:30:25the blood. Two, the second K in diabetic
1:30:28ketoacidosis refers to cosm breathing.
1:30:31What does cosm breathing mean? It means
1:30:33a deep and rapid breathing pattern.
1:30:35Three. The third K indicates a high
1:30:38level of potassium in the blood. The A
1:30:41in diabetic keto acidosis stands for
1:30:43three conditions that start with an A.
1:30:46Firstly, they are acidotic, a kind of
1:30:48acidosis called metabolic acidosis.
1:30:51Secondly, these patients might have an
1:30:53acetone breath. This means their breath
1:30:55might have a fruity smell. Lastly, they
1:30:57might experience anorexia due to nausea.
1:31:00Anorexia here refers to a lack of
1:31:02appetite which occurs because the
1:31:04individual feels nauseous. So if you
1:31:07were to ask me what are the signs and
1:31:09symptoms of diabetic ketoacidosis, I
1:31:12would describe them as follows.
1:31:14Dehydration. Indications include dry
1:31:16mucous membranes, a weak pulse, dry
1:31:19skin, and headache. When someone is
1:31:21dehydrated, their skin loses elasticity,
1:31:24appearing dry. It also can become hot
1:31:26and flushed, similar to an overheated
1:31:29car engine. Just as a car requires water
1:31:31to prevent overheating, our bodies need
1:31:34water to regulate temperature. Ketones
1:31:36found in urine, but more importantly in
1:31:39the blood. Acidosis, acetone breath, and
1:31:42anorexia due to nausea. When treating
1:31:45diabetic keto acidosis, the patient is
1:31:47usually dehydrated with high blood sugar
1:31:49levels. The treatment involves
1:31:51administering intravenous fluids at a
1:31:53rapid rate. Alongside the fluids,
1:31:56regular insulin is introduced. So the
1:31:58specific type of introvenous solution
1:31:59used whether it's normal saline 0.45%
1:32:03sodium chloride solution with 5%
1:32:05dextrose or 5% dextrose in water doesn't
1:32:09typically matter. Now when we talk about
1:32:11another condition hyperosmolar
1:32:13hyperglycemic non-catic syndrome or HHNK
1:32:18or HHNS or HHNC
1:32:22it's essential to know that it is
1:32:24primarily associated with type 2
1:32:26diabetes. HHNK can seem daunting due to
1:32:29its lengthy name but it's relatively
1:32:32straightforward. At its core, HHNK is
1:32:35fundamentally about dehydration.
1:32:38Long-term complications of diabetes such
1:32:40as renal failure, gangrine, stasis
1:32:43ulcers, blindness, impetence, heart
1:32:46disease, and brain disease arise due to
1:32:49two primary factors, poor tissue
1:32:51profusion, and peripheral neuropathy.
1:32:54The best lab test that indicates
1:32:56long-term blood glucose control is the
1:32:59hemoglobin A1C test, also known as the
1:33:03glycosillated hemoglobin test. Ideally,
1:33:05the result should be 6% or lower. If
1:33:08it's 8% or higher, it indicates poor
1:33:11control, while a result around 7%
1:33:14suggests borderline control and requires
1:33:17further investigation. Before we move
1:33:19ahead, let me take a quick moment to
1:33:21tell you something that could completely
1:33:23change your ENLEX journey. If you're
1:33:26serious about passing the ENCLEX in just
1:33:28one week or even within a month, then
1:33:30the smartest move you can make right now
1:33:31is to enroll in our complete online
1:33:34ENLEX crash course. This isn't just
1:33:35another course. It's a shortcut, a clear
1:33:37step-by-step road map that has already
1:33:39helped over 100,000 nursing students
1:33:41pass the ENCLEX with confidence. And
1:33:42here's the most incredible part. Not a
1:33:44single student who completed this course
1:33:46has failed. Yes, that's a 100% passing
1:33:48rate. We built this course based
1:33:50entirely on the feedback and insights of
1:33:52thousands of nurses who've successfully
1:33:54cleared the enollex in the last 5 years.
1:33:56That means we've removed all the fluff
1:33:57and focused only on what truly matters
1:33:59for your exam. Here's exactly what
1:34:00you'll get when you enroll. You'll get
1:34:02100 hours of animated crash course
1:34:04content designed for rapid revision, 500
1:34:06hours of comprehensive recorded lectures
1:34:08covering all the high yield topics, and
1:34:09access to 10,000 real and clelex
1:34:12questions to sharpen your test taking
1:34:13skills. You'll also get 500 nextgen
1:34:15case-based questions to strengthen your
1:34:17clinical judgment along with 15
1:34:18full-length practice tests that simulate
1:34:20the real ENLEX experience. And of
1:34:22course, you'll receive our complete
1:34:24Enclelex ebook and PDF notes, plus one
1:34:26full year of access so you can study at
1:34:28your pace on your schedule. And yes,
1:34:29we're currently offering a 70% discount
1:34:32for a very short period. Once the offer
1:34:34ends, it's gone. Thousands of students
1:34:35are enrolling in our online ENLEX course
1:34:37every month and passing the exam. But if
1:34:39you don't enroll now, you risk being
1:34:40left behind. Spots are filling fast and
1:34:42only a few seats are left. Visit our
1:34:44website to enroll now. Link is given in
1:34:46description box. Let's continue the
1:34:47video. The next topic is blood
1:34:50transfusion. Before we dive deep into
1:34:52this topic, I want to tell you that you
1:34:54will see at least one or two questions
1:34:57on this in your next exam. So, sharpen
1:34:59your focus because every detail could be
1:35:02that golden nugget that you're looking
1:35:04for. Let's begin the topic. Types of
1:35:07blood components. packed red blood cells
1:35:09or PRBC's. PRBC's are used to replenish
1:35:13ariththraittes. A unit typically infuses
1:35:16over a period of 2 to four hours. Each
1:35:18unit can increase the hemoglobin level
1:35:20by approximately 1 g per deciliter and
1:35:22the hemocrit by around 3%. Lab values
1:35:25typically reflect this change 4 to 6
1:35:27hours post transfusion. Effectiveness is
1:35:30gauged by the alleviation of anemia
1:35:32symptoms and a rise in ariththraite,
1:35:34hemoglobin, and hemetrate counts. Lucasy
1:35:37depleted units are those with lucasytes,
1:35:39proteins and plasma have been minimized.
1:35:42Their primary purpose is to enhance the
1:35:44oxygen carrying capacity of the blood
1:35:46and restore intravascular volume. For
1:35:48individuals with prior allergic
1:35:50transfusion reactions or those who have
1:35:52had hematopiadic stem cell transplants,
1:35:55washed red blood cells devoid of plasma
1:35:57platelets and luccoytes might be
1:35:59recommended. Lucco reduction achieved
1:36:01through filtration, washing or freezing
1:36:04diminishes the WB count in a unit of
1:36:06pack cells. Platelet transfusion
1:36:08platelets treat thrombocyipenia and
1:36:10platelet functionality issues. After
1:36:12receiving multiple platelet units,
1:36:14clients may develop aloe immunization to
1:36:17various platelet antigens. Such
1:36:19individuals may benefit more from HLA
1:36:21matched platelets. While not obligatory,
1:36:24cross matching is typically performed.
1:36:26Platelet concentrates have minimal RBCs.
1:36:29Platelet unit volumes can differ. Always
1:36:31inspect the bag to determine the
1:36:33components volume. Platelets should be
1:36:35administered promptly once they arrive
1:36:37from the blood bank, typically within 15
1:36:39to 30 minutes. The efficacy of the
1:36:41transfusion is judged by the rise in
1:36:43platelet count. Normally, platelet
1:36:45counts are checked 1 hour post
1:36:47transfusion and again 18 to 24 hours
1:36:50later. An increment of 5,000 to 10,000
1:36:53mm cube is anticipated for each platelet
1:36:55unit transfused. Fresh frozen plasma.
1:36:58Fresh frozen plasma provides clotting
1:37:00factors or volume expansion but lacks
1:37:03platelets. This plasma is infused within
1:37:052 hours of being thawed to maintain the
1:37:07viability of clotting factors. The
1:37:09infusion process lasts about 15 to 30
1:37:12minutes. Both RH and compatibility
1:37:15are prerequisites for plasma product
1:37:17transfusion. The transfusion success is
1:37:20evaluated by tracking coagulation tests
1:37:22especially proth throen time and partial
1:37:25throbboplastin time and by checking the
1:37:27resolution of hypoalmia.
1:37:29Cryoprecipitates cryoprecipitates are
1:37:32derived from fresh frozen plasma. They
1:37:34can be stored for up to a year but once
1:37:36thawed they must be used immediately. A
1:37:39unit is typically administered within 15
1:37:41to 30 minutes. They are primarily
1:37:43utilized to replenish clotting factors,
1:37:45notably factor 8 and fibbrinogen. To
1:37:48determine the transfusion's
1:37:49effectiveness, coagulation tests and
1:37:51fibbrinogen levels are closely
1:37:53monitored. Granul sites. Granul sites
1:37:55are suitable for treating sepsis or
1:37:57neutropenic patients with infections
1:37:59resistant to antibiotics. Effectiveness
1:38:02is evaluated by monitoring WBC and
1:38:04differential counts. Document relevant
1:38:07information about the transfusion in the
1:38:08medical record, noting clients
1:38:10tolerance, response, and the
1:38:12transfusion's effectiveness. Types of
1:38:14blood donations. Autotologist donations.
1:38:17Clients donate their own blood for
1:38:19scheduled procedures to minimize disease
1:38:21transmission and potential transfusion
1:38:23issues. Not suitable for patients with
1:38:25leukemia or bacteria. Donations can be
1:38:28made every 3 days provided hemoglobin is
1:38:30safe. Donation should start within 5
1:38:32weeks of transfusion and cease at least
1:38:343 days before the procedure. Blood
1:38:37salvage. Autotologist donation involving
1:38:39suctioning blood from enclosed body
1:38:41site. Blood might require washing to
1:38:43remove tissue debris before reinfusion.
1:38:46Designated donor. Recipients choose
1:38:48their compatible donors. It doesn't
1:38:50reduce infection risk, but offers donor
1:38:53identification comfort to recipients.
1:38:56Compatibility. Blood samples from
1:38:58recipients are labeled at bedside with
1:39:00identity verification. Recipients
1:39:03and Rh types are determined. An
1:39:05antibbody screen is performed to
1:39:07identify other antibodies. Compatibility
1:39:10is assessed through crossmatching.
1:39:11Compatibility is confirmed if no RBC
1:39:14aglutination takes place. People who are
1:39:17AB positive are universal recipients,
1:39:20meaning they can safely receive a blood
1:39:22transfusion from any other blood type. O
1:39:24negative individuals are universal
1:39:25donors, meaning their blood can be given
1:39:27to people of any blood type. Rh positive
1:39:30individuals can receive blood from Rh
1:39:32negative donors. However, Rh negative
1:39:35recipients should avoid Rh positive
1:39:37blood. Incompatibility can lead to
1:39:40severe transfusion reactions. Infusion
1:39:42pumps suitable for blood products if
1:39:45they function with opaque solutions. Use
1:39:47specific IV tubing for blood products.
1:39:50Dedicated manual pressure cuffs can be
1:39:52used to adjust flow rate, maxing out at
1:39:55300 mm of HG. Regular Spigo monometer
1:39:58cuffs shouldn't be used. They don't
1:40:01provide consistent pressure on the bag.
1:40:03Blood warmers. You might wonder why we
1:40:05need them. Well, they're essential to
1:40:07ensure patients don't experience
1:40:09hypothermia or have any adverse
1:40:11reactions during multiple transfusions.
1:40:13It's vital to only use devices
1:40:15specifically approved for this job. And
1:40:17a little pro tip, never, and I mean
1:40:19never, think, of using microwaves or hot
1:40:22water to warm up blood. It's just not
1:40:25safe. Now, since we're on the topic of
1:40:26blood transfusion, there are some key
1:40:28points that you should absolutely
1:40:30remember. Always provide accurate
1:40:33recipient details to the blood bank and
1:40:35keep a good record of it. Remember, only
1:40:37authorized personnel can pick up blood
1:40:39from the blood bank. Let's avoid
1:40:41mistakes. Only transport one blood unit
1:40:43to one patient at a time. Make sure you
1:40:45inform the patient about what's going on
1:40:47and don't forget to ask about their past
1:40:49transfusion experiences. A fever in the
1:40:52patient, check in with the health care
1:40:53provider before starting the
1:40:55transfusion. Always ensure the patient
1:40:57has given informed consent and keep an
1:40:59eye on their vital signs and evaluate
1:41:01the renal, circulatory, and respiratory
1:41:03health. Let me share some of the common
1:41:05mistakes and tips to avoid
1:41:07complications. Be careful with quick
1:41:09infusions of cold blood through a
1:41:11central venus catheter. It can trigger
1:41:13cardiac dysriythmia. Always inspect the
1:41:15blood bag for any issues, leaks, weird
1:41:17colors, clots, bubbles, everything.
1:41:20Monitor the patients vitals and lung
1:41:22sounds during the entire process. Be
1:41:25timely. Infuse within the recommended
1:41:27time frame. Like for packed red blood
1:41:30cells, stick to 2 to 4 hours. Always
1:41:32check expiration dates on blood bags.
1:41:34Store blood in the right refrigerators.
1:41:36If not used timely, return it to the
1:41:39blood bank. Medications and blood, they
1:41:41don't mix, so don't combine them. Only
1:41:43normal saline should accompany blood
1:41:45components and always ensure that the
1:41:48blood type is a match. We don't want any
1:41:51unpleasant surprises. Remember, safety
1:41:53first. Use an 18 or 19 gauge IV needle
1:41:56to ensure smooth flow and to avoid
1:41:59damaging those RBCs. Use specific sets
1:42:01for blood transfusion with Y tubing or
1:42:04straight tubing with filters. If a
1:42:06patient has history of reactions,
1:42:07premedication might be needed. Keep an
1:42:09eye out for any signs of transfusion
1:42:11reactions during the procedure,
1:42:13especially in the initial 15 minutes,
1:42:15and document everything. And on that
1:42:17note, let's discuss some complications
1:42:19to be aware of. Circulatory overload.
1:42:22This happens when blood is infused too
1:42:24quickly. Symptoms include coughing,
1:42:26chest pain, headaches, and more. If this
1:42:28happens, slow down the infusion rate and
1:42:30contact the healthcare provider.
1:42:32Sepacemia. This is when the transfused
1:42:34blood is contaminated. It can lead to
1:42:36chills, fever, vomiting, and even shock.
1:42:38If you suspect this, immediately alert
1:42:40the healthcare provider and obtain blood
1:42:42cultures and cultures of the blood bag.
1:42:45Iron overload. What is it? This is a
1:42:47delayed issue we notice in patients
1:42:49who've had multiple transfusions. Think
1:42:50of those with conditions like anemia or
1:42:52thrombocytoenia. Symptoms to watch for
1:42:55are episodes of vomiting, diarrhea, a
1:42:57sudden drop in blood pressure and
1:42:59fluctuations in regular blood readings.
1:43:01What can we do? Administer drugs like
1:43:03deferoxamine, either IV or
1:43:05subcutaneously. Why? This helps in
1:43:07removing excess iron from the body. Keep
1:43:09an eye on urine color. It might show a
1:43:11reddish hue because of iron being
1:43:13expelled. This treatment is stopped once
1:43:15the serum iron levels are back to
1:43:17normal. Hypocalcemia. Let's decode. The
1:43:20citrate in the transfused blood loves
1:43:22calcium, so it binds with it leading to
1:43:25its ejection from our body. Clinical
1:43:26indicators. Always check the serum
1:43:28calcium levels before and after giving a
1:43:30transfusion. Keep tabs on hypocalcemia
1:43:33signs, overactive reflexes, tingling
1:43:36sensations, muscle spasms. In your
1:43:38action plan, if you see these signs,
1:43:40slow down the transfusion and give your
1:43:42HCP a heads up. Hyperc calmia. What's
1:43:45happening? Old stored blood releases
1:43:47potassium due to cell breakdown. Steps
1:43:49for care. Remember, the older the blood,
1:43:51the more potassium, especially in
1:43:53patients with kidney issues. Fresh blood
1:43:55is preferable. Always cross-check the
1:43:57storage state on the blood bag and keep
1:43:59an eye on potassium levels. Look out for
1:44:01signs. Numbness, fatigue, stomach
1:44:03cramps. If in doubt, slow down the
1:44:06transfusion and bring it to your HCP's
1:44:08attention. Citrate toxicity. Citrate is
1:44:10an anti-coagulant in blood products. But
1:44:13guess what? It gets processed by the
1:44:14liver. Rapid transfusion can make levels
1:44:16of calcium and magnesium drop causing
1:44:18citrate toxicity. This is bad news as it
1:44:21affects the heart and blood's ability to
1:44:23clot. Our patients with liver issues or
1:44:26very young ones with immature livers
1:44:28need extra caution. Before we move
1:44:29ahead, let me take a quick moment to
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1:45:56description box. Let's continue the
1:45:57video. The next topic is positioning of
1:46:00the patient. Attention students, this
1:46:03topic is hot for your upcoming exam.
1:46:07Expect at least two or three questions
1:46:09directly from here. Don't miss a beat.
1:46:12Watch every second of this video with
1:46:14laser focus. Master this and you'll be
1:46:18one step closer to acing that paper.
1:46:20Now, always position your client in a
1:46:23way that ensures both safety and utmost
1:46:26comfort. Also, keep in mind the client's
1:46:28medical history and conditions. If
1:46:30someone just had surgery, certain
1:46:33positions might aggravate their
1:46:34condition or hinder their healing
1:46:36process. Here we will discuss various
1:46:39positions for specific conditions.
1:46:41Autographs. After a surgery like this,
1:46:44you must keep the site completely still,
1:46:47usually between 3 to 7 days. It is
1:46:50crucial as it allows the grafted skin to
1:46:52stick properly. Face and headburns. In
1:46:54such cases, elevate the head of the bed.
1:46:57It's not just for comfort, but to
1:46:59prevent scary complications like facial
1:47:01or tracheal edema, burns around the arms
1:47:04or legs. Elevate these limbs higher than
1:47:06the heart. It's like giving them a
1:47:08little pedestal of their own to prevent
1:47:10swelling. Skin graft. Here you should be
1:47:13gentle. Elevate and immobilize the graph
1:47:15site, ensuring there's no unnecessary
1:47:18movement. And no, they shouldn't be
1:47:20standing on it either. Mastctomy. For
1:47:22clients who've had this surgery, always
1:47:24prop them up at least 30°. Think of it
1:47:27as the queen or king reclining on their
1:47:30throne position and elevate their
1:47:32affected arm on a pillow. It aids in
1:47:34fluid drainage and gives them some
1:47:36relief. Only turn the client to their
1:47:38back or the side that hasn't been
1:47:40operated on. The affected side needs its
1:47:43beauty rest. Perennial and vaginal
1:47:45procedures. Here's a position straight
1:47:47out of your yoga class. The lithottomy
1:47:49position. It's the best way to ensure
1:47:51access and comfort for the client post
1:47:54procedure. Hypopasectomy. Imagine you're
1:47:56trying to balance a delicate scale. If
1:47:58someone has undergone a hypoasectomy,
1:48:00which means removal of the pituitary
1:48:03gland, our master control gland, we must
1:48:06make sure there's no added pressure in
1:48:08the head area. Think of this as
1:48:10adjusting the weights on the scale. So
1:48:12we elevate the head of the bed slightly.
1:48:15Why? This reduces the risk of
1:48:16intraraanial pressure that might cause
1:48:19complications. Thyroid ectomy. The
1:48:21thyroid gland shaped like a butterfly
1:48:23sits comfortably at the front of our
1:48:25neck. When it's removed, we need to
1:48:27imagine we're cradling that area with
1:48:29utmost care. So we place the client in a
1:48:32semifers to fowlers position. This angle
1:48:35helps reduce swelling and gives a little
1:48:37comfort to the area where our
1:48:39butterflyike gland once sat. Think of it
1:48:42like supporting a delicate sculpture. We
1:48:44might use sandbags, pillows, or other
1:48:47stabilizers to ensure the head and neck
1:48:49remain steady. Ever been told not to
1:48:51stretch a new rubber band too hard?
1:48:53Similarly, we don't want to extend the
1:48:55neck too much as it may strain the area
1:48:58where surgery was done. Hemorrhoid
1:48:59ectomy. It's all about comfort after
1:49:02this procedure, which deals with the
1:49:04removal of swollen veins in the rectal
1:49:06region. In this case, it's best to lay
1:49:08on the side, which prevents pain and
1:49:10potential bleeding. Gastroosophical
1:49:12reflux disease or gird. Think of a
1:49:16seessaw. With gird, we want the stomach
1:49:18end lower than the esophagus to avoid
1:49:20food and acid moving upwards. The
1:49:22reverse trendelenberg's position tilts
1:49:25the body with the head elevated higher
1:49:27than the feet. It's like creating a
1:49:29downhill for the stomach content so it
1:49:31doesn't flow back into the esophagus.
1:49:33Liver biopsy. We gently and carefully
1:49:36assist them onto their right side. Why
1:49:38the right side, you ask? Well, the liver
1:49:40is situated on the right side of the
1:49:42body, tucked neatly under the rib cage.
1:49:44By lying on this side, we're applying
1:49:46some gentle pressure to the wound area,
1:49:49which can help reduce any potential
1:49:51bleeding and offer added support to the
1:49:53puncture site. But wait, we can offer
1:49:56even more comfort. Think of a pillow or
1:49:59folded towel as a miniature soft shield.
1:50:02By placing the shield beneath the
1:50:04puncture site, it provides cushioning
1:50:06and further ensures the area remains
1:50:08stable. Paracentesis. Imagine needing to
1:50:10access fluid in the abdominal area. For
1:50:13this, we'd have our patient either in a
1:50:15semifowers position or sitting upright.
1:50:17Think of it as allowing for space for
1:50:19the procedure. Once it's done, our
1:50:21priority is comfort. So we help the
1:50:23patient find a relaxing position.
1:50:24Nasogastric tube insertation will prop
1:50:27the client up into a high fowlers
1:50:29position. Why? Because tilting the head
1:50:32forward magically helps close the
1:50:34windpipe or trachea and opens up the
1:50:36esophagus. Imagine trying to slip into a
1:50:39busy street versus an open alleyway. For
1:50:41nasogastric irrigations and feedings,
1:50:44elevate the bed's head to prevent our
1:50:46patient from aspirating or accidentally
1:50:49letting fluids go down the windpipe.
1:50:50Remember to maintain this elevation
1:50:52especially after feeding like allowing
1:50:55time for digestion, rectal anemma and
1:50:57irrigations. Place the client in the
1:50:59left sims position as it's like letting
1:51:02water flow downstream in a river. This
1:51:04takes advantage of the colon's natural
1:51:06pathway. Sangston Blakemore and
1:51:07Minnesota tubes. They might sound like
1:51:10names of rock bands, but these tubes,
1:51:12though not a fan favorite, sometimes are
1:51:15a necessity if we have to use them.
1:51:17Keeping the head elevated helps both in
1:51:19lung expansion and reducing blood flow
1:51:22in specific areas. Chronic obstructive
1:51:24pulmonary disease, COPD. In severe
1:51:28cases, think of giving the client a pose
1:51:30like they're in deep thought over a
1:51:32desk. Sitting, leaning forward with arms
1:51:35over pillows or a table makes breathing
1:51:37easier and more effective. Larangtomy,
1:51:39we aim to keep the airway open and
1:51:41reduce swelling. A semifoulers or
1:51:44fowlers position is like giving a clear
1:51:46tunnel for air flow. Post broncoscopy.
1:51:49After examining the main passageways of
1:51:50the lungs, we position the patient in a
1:51:52semifers position. This helps in
1:51:54preventing any unwanted particles from
1:51:56going down the wrong way. Considering
1:51:58their swallowing might be momentarily
1:52:00impaired. Postural drainage. Imagine
1:52:03you're pouring a drink. You want to
1:52:04ensure the last drop goes into the
1:52:06glass. So you position the bottle such
1:52:09that the remaining liquid is at the very
1:52:10top. Similarly, in postural drainage,
1:52:13the segment of the lung we want to drain
1:52:15needs to be in the highest position.
1:52:17Think of it as tilting the bottle. We
1:52:19sometimes use the trendelenberg's
1:52:21position, thorosentesis. Visualize a
1:52:24ketchup packet. To get every drop out,
1:52:27you squeeze from the bottom and position
1:52:29it to one side. Similarly, during
1:52:31thorosentesis, picture someone leaning
1:52:34over a table trying to get a good view
1:52:35of something on the ground. That's our
1:52:37patient. They sit on the bed's edge,
1:52:39leaning over the bedside table with feet
1:52:41propped up on a stool. Alternatively,
1:52:44they can lay in bed on the unaffected
1:52:46side, sort of propped up like they're
1:52:48watching TV in a relaxed position. In
1:52:50other words, Fowlers's position.
1:52:52Abdominal aneurysm resection. Imagine
1:52:54after a big operation, our pipe needs
1:52:58minimal bending. So, we make sure the
1:53:00head of the bed is elevated, but only to
1:53:0245°. Amputation of the lower extremity.
1:53:05Within the first day, we prop the foot
1:53:07of the bed up. It's like elevating a
1:53:09repaired toy to let the glue set. We use
1:53:11pillows, but ensure not to elevate too
1:53:13much because we don't want it to bend at
1:53:16awkward angles. Regular stretching as
1:53:18prescribed is essential. Imagine doing
1:53:20yoga twice a day to ensure flexibility.
1:53:22This is to avoid any stiffness setting
1:53:24in arterial vascular grafting of an
1:53:27extremity. Imagine a newly planted
1:53:29sapling. The tree is kept straight and
1:53:32undisturbed for a day, ensuring its
1:53:34roots grab hold. Similarly, the affected
1:53:36limb is kept straight. Movements are
1:53:39restricted like making sure kids don't
1:53:41play near our new tree. Cardiac
1:53:43cathization. Think of a freshly painted
1:53:46wall. If we assess the wall or in this
1:53:49case, the femoral vessel, we let it dry
1:53:52or stabilize. It's like when we paint a
1:53:55wall and ensure no one touches it. The
1:53:58patient stays in bed, though they can
1:54:00turn side to side. The limb we worked on
1:54:02is kept straight, and the head is not
1:54:04lifted too high, no more than 30°. It is
1:54:07like ensuring our freshly painted wall
1:54:09isn't smudged. Heart failure and
1:54:11pulmonary edema. Imagine this. Your city
1:54:15is flooded and the waters are rising in
1:54:17the downtown area. What do you do
1:54:19exactly? Move to higher ground. In the
1:54:21same way, when someone is dealing with
1:54:22heart failure or pulmonary edema, we
1:54:25want to position the client upright. let
1:54:27their legs dangle over the side of the
1:54:29bed. Why? This reduces the flood or in
1:54:32our case decreases venous return and
1:54:34eases the lung congestion. And remember,
1:54:37many clients with respiratory and
1:54:39cardiac issues generally benefit from
1:54:41having their head elevated. Peripheral
1:54:43arterial disease. Okay, now let's talk
1:54:46about the arterial highways of our body.
1:54:48Sometimes there's a traffic jam because
1:54:50of swelling. The key here, elevation,
1:54:52but not too high. We don't want to slow
1:54:56down the traffic. So raise the feet but
1:54:59not above the head. Some clients might
1:55:02need their feet a bit lower to keep
1:55:04blood flowing smoothly. Varicose veins.
1:55:06Think of these as the bumpy uneven roads
1:55:09in our city. For these, elevating the
1:55:11legs above heart level is the way to go.
1:55:14But just like avoiding potholes, folks
1:55:16should try not to sit or stand for too
1:55:18long. Venice insufficiency and leg
1:55:20ulcers. When the drainage system is
1:55:22clogged, elevating the leg can help
1:55:24clear it out. Cataract surgery. After
1:55:26this operation, imagine propping up the
1:55:28main statue in our city center. Elevate
1:55:30the head of the bed and either lay on
1:55:32the back or the unoperated side. This
1:55:35stops excess fluid from gathering at the
1:55:37operated site. Retinal detachment. This
1:55:39is like a major billboard in our city is
1:55:41hanging off the edge. Sometimes you'll
1:55:43need to completely close off the area
1:55:45like bed rest and patching both eyes.
1:55:48Autonomic dysrelexia. This one is
1:55:51critical, guys. Imagine a sudden storm
1:55:53hitting our city. Immediately elevate
1:55:55the control tower, or in our case, the
1:55:58head of the bed to a high fowler's
1:56:00position. This helps us navigate the
1:56:02storm, ensuring enough air and avoiding
1:56:05a disastrous hypertensive event.
1:56:08Cerebral aneurysm. Imagine your brain as
1:56:11a delicate garden where too much water
1:56:13or pressure could be harmful. To ensure
1:56:16just the right amount of pressure, lie
1:56:18down. But make sure the top part of your
1:56:20bed is tilted 30 to 45° upwards. This
1:56:23delicate angle avoids putting too much
1:56:26pressure on the area of the aneurysm.
1:56:28Cerebral angography. Keep the arm where
1:56:30the contrast medium was injected
1:56:32straight and still for about 6 to 8
1:56:34hours. Stroke or brain attack. It's like
1:56:36a storm in the brain. Depending on the
1:56:38type, a hemorrhage stroke, you elevate
1:56:41the bed's head to 30° helping drain out
1:56:44the storm. ES schemic stroke. Keep the
1:56:46bed flat for optimal care. Always keep
1:56:49your head straight and in the middle.
1:56:51Avoid making sharp bends with your hips
1:56:53and neck. It's a bit like ensuring
1:56:54proper drainage after heavy rain.
1:56:56Cranottomy. Imagine your skull as a
1:56:58protective helmet. When a part of this
1:57:01helmet is removed, like during a
1:57:03cranottomy, don't lie down on the
1:57:05operated side. Tilt your bed's head 30
1:57:07to 45° upwards and keep your head
1:57:10straight and avoid extreme bending.
1:57:12Laminctomy and vertebral surgery. When
1:57:14lying, think of turning your entire body
1:57:17as one solid log lumbar puncture.
1:57:19Getting this test is like forming a C
1:57:22with your spine. Lie on your side during
1:57:24the test, curving like the letter C.
1:57:26After the test, lie on your back for a
1:57:28while. All before we move ahead, let me
1:57:30take a quick moment to tell you
1:57:32something that could completely change
1:57:34your enclelex journey. If you're serious
1:57:36about passing the Enclelex in just one
1:57:38week or even within a month, then the
1:57:40smartest move you can make right now is
1:57:42to enroll in our complete online ENLEX
1:57:44crash course. This isn't just another
1:57:46course, it's a shortcut. A clear
1:57:47step-by-step road map that has already
1:57:49helped over 100,000 nursing students
1:57:51pass the ENCLEX with confidence. And
1:57:52here's the most incredible part. Not a
1:57:54single student who completed this course
1:57:56has failed. Yes, that's a 100% passing
1:57:59rate. We built this course based
1:58:00entirely on the feedback and insights of
1:58:02thousands of nurses who've successfully
1:58:04cleared the ENLEXs in the last 5 years.
1:58:06That means we've removed all the fluff
1:58:07and focused only on what truly matters
1:58:09for your exam. Here's exactly what
1:58:10you'll get when you enroll. You'll get
1:58:12100 hours of animated crash course
1:58:14content designed for rapid revision, 500
1:58:16hours of comprehensive recorded lectures
1:58:18covering all the high yield topics, and
1:58:20access to 10,000 reallex questions to
1:58:22sharpen your test taking skills. You'll
1:58:24also get 500 NextGen case-based
1:58:26questions to strengthen your clinical
1:58:27judgment along with 15 fulllength
1:58:29practice tests that simulate the real
1:58:31enclelex experience. And of course,
1:58:33you'll receive our complete Enclelex
1:58:34ebook and PDF notes, plus one full year
1:58:37of access so you can study at your pace
1:58:38on your schedule. And yes, we're
1:58:40currently offering a 70% discount for a
1:58:42very short period. Once the offer ends,
1:58:44it's gone. Thousands of students are
1:58:45enrolling in our online ENLEX course
1:58:47every month and passing the exam. But if
1:58:49you don't enroll now, you risk being
1:58:51left behind. Spots are filling fast and
1:58:52only a few seats are left. Visit our
1:58:54website to enroll now. Link is given in
1:58:56description box. Let's continue the
1:58:57video. Welcome to the next topic. Legal
1:59:01aspects of nursing. Types of law.
1:59:04Contract law. This is about keeping
1:59:06promises between people. Civil law. It's
1:59:08about protecting people's rights and
1:59:10handling issues between individuals. It
1:59:13doesn't involve big threats to society.
1:59:16Criminal law. This deals with actions
1:59:18that could harm society. Crimes are
1:59:21serious offenses against the law. Either
1:59:23less serious, called a misdemeanor, or
1:59:26more serious, called a felony. Tort law.
1:59:29A tort is when someone does something
1:59:32wrong that hurts another person. It's
1:59:34not a contract issue, and the injured
1:59:36person can ask for compensation. Tort
1:59:39laws address wrongdoings causing harm,
1:59:42but there are two main types,
1:59:44intentional and unintentional.
1:59:46Unintentional tors. harm or injury
1:59:50caused accidentally or due to negligence
1:59:53without deliberate intent. Types of
1:59:56unintentional tors. Negligence and
1:59:58malpractice. Negligence. Negligence is
2:00:01doing something that a careful person
2:00:03wouldn't do. We compare actions to
2:00:05what's reasonable in a situation.
2:00:07Malpractice. Malpractice is when
2:00:10professionals like nurses make mistakes
2:00:13due to misconduct or not having enough
2:00:16skill. It's like a serious form of
2:00:18negligence for experts. Examples of
2:00:21negligence or malpractice. Accidental
2:00:23burns inflicted on a client through the
2:00:25use of a heating pad. Objects
2:00:27inadvertently left within a client's
2:00:29body after a surgical procedure.
2:00:32Inadequate assessments compromising the
2:00:34quality of patient care. Administration
2:00:37errors involving incorrect medications
2:00:39or missed doses. Intentional tors.
2:00:42Intentional tor happens when someone
2:00:45purposefully does something to harm
2:00:47another person or their property. It's
2:00:50when harm is done on purpose, not by
2:00:53accident. Types of intentional tors.
2:00:55Assault, threatening someone with
2:00:57physical harm, making them fear an
2:00:59attack. Battery. Physically harming
2:01:01someone intentionally, like hitting or
2:01:04punching. False imprisonment, illegally
2:01:07confining or restraining someone against
2:01:09their will. Defamation. Defamation is
2:01:12when someone says or writes something
2:01:14untrue about another person hurting
2:01:17their reputation. It can be in writing
2:01:19called liel or spoken called slander.
2:01:22Intentional infliction of emotional
2:01:25distress. Purposely causing severe
2:01:27emotional distress to someone. Fraud.
2:01:30Deceiving someone intentionally to gain
2:01:32an unfair advantage. Now understanding
2:01:35treatment for minors. Who is a minor? A
2:01:39minor is someone under a certain age set
2:01:41by the law, usually less than 18 years
2:01:44old getting consent. Minors cannot
2:01:46legally agree on their own, so they need
2:01:49permission from a parent or guardian.
2:01:51When consent is needed, in most cases,
2:01:54treatment for a minor needs the patient
2:01:56or guardians permission. But there are
2:01:58exceptions. Emergencies, certain health
2:02:00issues like substance abuse or
2:02:02infections. When a minor can decide if
2:02:05the minor is independent, emancipated,
2:02:07or when there's a court order.
2:02:10Emancipated minor. An emancipated minor
2:02:12is someone who became independent
2:02:14through marriage, pregnancy, joining the
2:02:17military, or a court order. An
2:02:19emancipated minor can legally give their
2:02:22own consent for treatment. Before moving
2:02:24on to the next topic, let's highlight a
2:02:27key point of utmost importance. Good
2:02:30Samaritan laws. These laws make sure
2:02:32that professionals help in an emergency
2:02:35and give proper care and they won't get
2:02:37in trouble. It encourages them to assist
2:02:40without worrying about legal problems.
2:02:42HIPPA, the Health Insurance Portability
2:02:45and Accountability Act, describes how
2:02:48personal health information, PHI, may be
2:02:51used in how the client can obtain access
2:02:54to the information. Advanced directive.
2:02:56It is a legal document that extends a
2:02:59person's control over health care
2:03:01decisions in the event that the person
2:03:03becomes incapacitated. They are called
2:03:05advanced directives because they
2:03:08communicate preferences before
2:03:10incapacitation occurs. Critical pathway.
2:03:13A critical pathway is like a map for
2:03:15taking care of a client. It helps plan
2:03:17and keep track of their progress within
2:03:19a certain time. The next topic is
2:03:21leadership styles. Autocratic
2:03:24leadership. In this type of leadership,
2:03:26the leader takes control and makes
2:03:28decisions. No input is sought from the
2:03:30group and it's like a strong guiding
2:03:32hand. Democratic or participative
2:03:35leadership. Everyone in the team
2:03:36contributes ideas. The leader supports
2:03:39and guides like a friend and
2:03:41communication flows more freely. Leair
2:03:44leadership leaders step back and give
2:03:46space. Team members take charge and
2:03:49decide. Minimal guidance is given by the
2:03:52leader. Situational leadership. The
2:03:54style changes based on what's needed.
2:03:56Flexibility to adapt to different
2:03:58situations. Bureaucratic leadership. The
2:04:01leader follows strict rules and
2:04:03procedures. Organizational guidelines
2:04:06are the main focus. The next topic is
2:04:09emergency department triage system. In
2:04:11emergency departments, a commonly used
2:04:14system rates patients in three tiers.
2:04:16Eme, urgent, and non-urgent. Emergent,
2:04:20red, priority one, or highest priority.
2:04:24This top priority goes to patients with
2:04:26life-threatening injuries requiring
2:04:28immediate attention and constant
2:04:30monitoring. These patients have a good
2:04:32chance of survival once stabilized.
2:04:34Examples include trauma victims, severe
2:04:36chest pain, cardiac arrest, limb
2:04:38amputation, acute neurological issues,
2:04:41and chemical eye injuries. Urgent yellow
2:04:44priority two assigned to patients
2:04:46needing treatment with
2:04:48nonlife-threatening complications, but
2:04:50they should be treated within 1 to 2
2:04:52hours. Continuous evaluation every 30 to
2:04:5560 minutes is needed. Examples include
2:04:58simple fractures, manageable asthma,
2:05:00fever, hypertension, abdominal pain, and
2:05:03renal stones. Non-urgent
2:05:05green priority three given to patients
2:05:08with local injuries lacking immediate
2:05:11complications. They can wait several
2:05:13hours for treatment with evaluation
2:05:15needed every 1 to two hours. Examples
2:05:19include minor cuts, sprains, or cold
2:05:22symptoms. Before we move ahead, let me
2:05:24take a quick moment to tell you
2:05:25something that could completely change
2:05:28your ENLEX journey. If you're serious
2:05:30about passing the ENLEX in just one week
2:05:32or even within a month, then the
2:05:34smartest move you can make right now is
2:05:35to enroll in our complete online ENLEX
2:05:38crash course. This isn't just another
2:05:39course. It's a shortcut, a clear
2:05:41step-by-step road map that has already
2:05:43helped over 100,000 nursing students
2:05:45pass the ENCLEX with confidence. And
2:05:46here's the most incredible part. Not a
2:05:48single student who completed this course
2:05:50has failed. Yes, that's a 100% passing
2:05:52rate. We built this course based
2:05:54entirely on the feedback and insights of
2:05:56thousands of nurses who've successfully
2:05:58cleared the enollex in the last 5 years.
2:06:00That means we've removed all the fluff
2:06:01and focused only on what truly matters
2:06:03for your exam. Here's exactly what
2:06:04you'll get when you enroll. You'll get
2:06:06100 hours of animated crash course
2:06:08content designed for rapid revision, 500
2:06:10hours of comprehensive recorded lectures
2:06:12covering all the high yield topics, and
2:06:13access to 10,000 reallex questions to
2:06:16sharpen your test taking skills. You'll
2:06:18also get 500 NextG case-based questions
2:06:20to strengthen your clinical judgment
2:06:21along with 15 fulllength practice tests
2:06:24that simulate the real enclelex
2:06:26experience. And of course, you'll
2:06:27receive our complete Enclelex ebook and
2:06:29PDF notes, plus one full year of access
2:06:31so you can study at your pace on your
2:06:33schedule. And yes, we're currently
2:06:34offering a 70% discount for a very short
2:06:36period. Once the offer ends, it's gone.
2:06:38Thousands of students are enrolling in
2:06:40our online ENLEX course every month and
2:06:41passing the exam. But if you don't
2:06:43enroll now, you risk being left behind.
2:06:45Spots are filling fast and only a few
2:06:47seats are left. Visit our website to
2:06:48enroll now. Link is given in description
2:06:50box. Let's continue the video. The next
2:06:53topic is parental nutrition. Before we
2:06:56dive into this topic, expect at least
2:06:59three or four questions from this topic
2:07:01on your next exam. So, keep those eyes
2:07:04peeled and take notes. All right,
2:07:07everyone. Let's dive into parental
2:07:09nutrition or PN as it's often called.
2:07:12Think of it as a lifeline for those who
2:07:14can't get nutrients the conventional
2:07:16way. Imagine supplying the body with
2:07:18essential nutrients directly through the
2:07:20veins. That's exactly what parental
2:07:22nutrition does. We have two types here,
2:07:25PPN or partial parental nutrition and
2:07:29TPN, total parental nutrition. Which one
2:07:32we choose depends on the specific needs
2:07:34of the patient. Let's break down what's
2:07:36in PN. There are carbohydrates presented
2:07:39as dextrose, fats that are emulsified,
2:07:42proteins appearing as amino acids, and
2:07:45then we have the vitamins, minerals,
2:07:47electrolytes, and water. What's great
2:07:49about PN? It helps our body conserve its
2:07:51energy resources, ensuring it doesn't
2:07:53start using up our subcutaneous fat or
2:07:56muscle protein. Now, a quick note. PN
2:07:58solutions are hypertonic, meaning they
2:08:01have higher concentrations of substances
2:08:03like glucose and amino acids. Why might
2:08:05someone need parental nutrition? It's
2:08:08perfect for individuals whose
2:08:09gastrointestinal tracts are sadly out of
2:08:12commission so they can't process or
2:08:14absorb nutrients effectively. Think of
2:08:16someone who can eat a bit but not enough
2:08:19to fulfill their daily nutritional
2:08:20requirements. PN to the rescue. It's
2:08:23also a boon for those recovering from
2:08:25multiple GI surgeries or trauma. For
2:08:27patients grappling with health
2:08:29challenges like AIDS, cancer, severe
2:08:31burn injuries, malnutrition, or
2:08:33undergoing chemotherapy, PN can be a
2:08:36lifecher. Remember, the preference is
2:08:39always to try oral nutrition or nastric
2:08:42tube feeding before jumping to PN. It's
2:08:44our backup when all else fails.
2:08:47Administering PN. When we're talking
2:08:48about PPN, it's typically given through
2:08:51a large distal vein in the arm using a
2:08:53regular IV catheter, a midline, or
2:08:56sometimes a pick, peripherally inserted
2:08:59central catheter. The midline often goes
2:09:02into veins in the upper arm like the
2:09:04brachial or syphalic veins. On the other
2:09:06hand, TPN is directly channeled into a
2:09:10central vein. Pick works here, but
2:09:12sometimes we might also use the
2:09:13subclavian or jugular veins. A quick
2:09:16nursing tip. If you ever notice that the
2:09:18bag of IV solution is empty and you're
2:09:20waiting for a replacement, start with a
2:09:2310% dextrose solution at the prescribed
2:09:25rate to keep hypoglycemia at bay. Get
2:09:28the prescribed solution as quickly as
2:09:29possible. Keep in mind that introducing
2:09:31hypertonic solutions into peripheral
2:09:34veins could lead to complications like
2:09:36sclerosis, flabitis, or swelling. Always
2:09:39monitor for these signs. Diving deeper
2:09:42into PN components, carbohydrates, the
2:09:44strength of the dextrose solution we use
2:09:46hinges entirely on the patients
2:09:48nutritional requirements and the
2:09:50delivery route. All right, everyone,
2:09:52keep these points in mind and let's
2:09:54ensure our patients get the best
2:09:56nutritional support possible. Dive in
2:09:58with me as we break down the essentials
2:10:00of administering solutions.
2:10:02Administration basics. Number one,
2:10:04whether you're going with a central or
2:10:06peripheral method, always follow the
2:10:08AY's guidelines. It's the golden rule.
2:10:10Number two, carbohydrates. Think of
2:10:12carbohydrates as your body's main fuel.
2:10:14They typically cater to 60 to 70% of our
2:10:17energy needs, and that's a significant
2:10:20chunk. Number three, amino acids. Yes,
2:10:23proteins. These concentrations vary.
2:10:26We're talking from 3.5% to a whopping
2:10:2920%. Remember, lower concentrations are
2:10:32typically used for peripheral veins,
2:10:34while the big guns, the higher
2:10:36concentrations are saved for central
2:10:38veins. And here's a fun fact. 15 to 20%
2:10:42of our energy should ideally come from
2:10:44proteins. Number four, fat emotions or
2:10:47lipids. Lipids chip in up to 30% of our
2:10:50energy needs. They're not just about
2:10:52calories. They also help prevent fatty
2:10:54acid deficiencies. These solutions can
2:10:56be administered either through a
2:10:57peripheral or central vein. But here's a
2:11:00quick trick. If you're adding it to the
2:11:02main IV set, use a Y connector. Most of
2:11:05these emotions come from familiar
2:11:07sources like soybean or safflower oil,
2:11:10but keep an eye out for potential
2:11:12allergies, especially with egg yolk in
2:11:13the mix. Our friends with glucose
2:11:15intolerance or diabetes might get a more
2:11:18significant chunk of their PN from
2:11:19lipids. It's a nifty way to keep those
2:11:21glucose levels in check. Now, always,
2:11:24and I mean always, check the bottle. Any
2:11:27separation, fat globules, or froth, red
2:11:31flag, send it back to the pharmacy. And
2:11:34remember, these lipid solutions are
2:11:36unique. No additional additives should
2:11:38be mixed in. When it comes to infusion,
2:11:41start slow. Monitor the patient for any
2:11:43adverse reactions. If anything seems
2:11:45off, halt the infusion and get the
2:11:48healthcare provider on the line.
2:11:49Vitamins. PN solutions usually have our
2:11:52vitamin needs covered with a standard
2:11:54multivitamin blend. However, individual
2:11:57vitamins can also be added if necessary.
2:11:59Minerals and trace elements. These come
2:12:02in various preparations and are crucial
2:12:04for keeping our metabolism ticking.
2:12:06Right? Now look at this diagram. For
2:12:08those of you who are more visual
2:12:10learners, it gives a fantastic overview
2:12:12of the placement of catheterss, both
2:12:14peripherally inserted and central. And
2:12:17here's something super important. Signs
2:12:19and symptoms of a bad reaction to
2:12:21lipids, chest and back pain, chills,
2:12:24fever, nausea. These are things we need
2:12:27to be vigilant about. It's essential
2:12:29knowledge. So, make sure you've got
2:12:31these down. Electrolytes. When it comes
2:12:33to PN therapy, not everyone's
2:12:35electrolyte requirements are the same.
2:12:37Factors such as body weight,
2:12:39malnutrition, catabolism, and the
2:12:42specific illness play a huge role.
2:12:44Moreover, the organ function and any
2:12:46ongoing electrolyte losses also matter.
2:12:48Water. How much water do we need in a PN
2:12:51solution? Well, it's mainly about
2:12:53balancing the electrolytes and meeting
2:12:55fluid requirements. Regular insulin. You
2:12:58might wonder why add insulin. It's
2:13:00because of the high concentration of
2:13:02glucose in the PN solution. We need to
2:13:04keep the blood sugar injected heperin. A
2:13:06nifty little addition to prevent that
2:13:08pesky fibrous clot from forming at the
2:13:11catheter tip. Administering and ending
2:13:13PN. There are two main types to
2:13:15understand. Continuous PN. This runs
2:13:1724/7 making it perfect for hospital
2:13:20scenarios. Intermittent or cyclic PN.
2:13:22This one's pretty flexible and often
2:13:24given overnight. This method allows
2:13:26patients to enjoy their daytime
2:13:28activities without the hassle of the IV
2:13:30setup. But remember, monitor those
2:13:32glucose levels. We don't want unexpected
2:13:35dips, especially when not infusing.
2:13:38Complications. Let's discuss some
2:13:40complications you might come across with
2:13:42parental nutrition. One of the major
2:13:44issues, air emolism. This can occur if
2:13:46the catheter system is opened or the IV
2:13:49tubing gets disconnected. Be extra
2:13:51cautious during IV tubing changes to
2:13:53prevent any air entry. Always remember
2:13:55to clamp all ports of the IV catheter.
2:13:58If this situation arises, immediately
2:14:00place the patient on their left side
2:14:02with their head positioned lower than
2:14:04their feet. Notify the healthare
2:14:05professional at once and ensure you
2:14:07administer oxygen. Next complication is
2:14:10hyperglycemia. So what causes it? Well,
2:14:13there are a few key reasons. First, it
2:14:15can occur when there's a high
2:14:16concentration of dextrose in a solution.
2:14:18Secondly, it might arise if a client is
2:14:21receiving a solution too rapidly.
2:14:23Another reason, a lack of sufficient
2:14:25insulin. And let's not forget infections
2:14:28can also be a contributing factor. Now,
2:14:30if you notice hypoglycemia signs, what
2:14:32should you do? First and foremost, get
2:14:35in touch with a healthcare provider. It
2:14:36might be necessary to adjust the
2:14:38infusion rate, perhaps slowing it down a
2:14:40bit. Regular monitoring of blood glucose
2:14:42levels is crucial and if prescribed,
2:14:45make sure to administer regular insulin.
2:14:47Next complication of parental nutrition
2:14:49is hypervolia. Now what is it? Think of
2:14:53it as the result of either giving too
2:14:55much fluid too quickly or simply
2:14:57administering excessive fluids.
2:14:58Conditions like renal dysfunction, heart
2:15:01failure or hepatic failure can also lead
2:15:04to hyperbalmia. So what do we do if we
2:15:06encounter it? First, you might want to
2:15:09slow down or even stop the IV infusion.
2:15:12Always make sure to alert the healthcare
2:15:13provider. Depending on the situation,
2:15:15you might also need to restrict fluids,
2:15:18maybe even prescribe directics. And in
2:15:20extreme cases, dialysis might be the way
2:15:22to go. Keep these interventions in mind.
2:15:24They're crucial. Next complication is
2:15:26hypoglycemia
2:15:28related to parental nutrition. Now, one
2:15:31thing to always remember is that if you
2:15:33suddenly stop PN, it can lead to
2:15:35hypoglycemia. Imagine this. If you've
2:15:37been giving too much insulin alongside
2:15:39the PN, you set up the body to expect a
2:15:42certain amount of glucose. So, when
2:15:45you're about to discontinue the PN,
2:15:47don't just stop it abruptly. What you
2:15:48should do is gradually reduce the PN
2:15:50solution. A helpful tip here is to
2:15:52infuse a 10% dextrose solution at the
2:15:55same rate as the PN. By doing this,
2:15:57you're essentially providing a buffer
2:15:59which can prevent hypoglycemia for about
2:16:011 to 2 hours after the PN has been
2:16:03stopped. And as always, keep an eye on
2:16:06those glucose levels. It's a good
2:16:08practice to monitor them closely and
2:16:10especially to check the glucose level
2:16:12about 1 hour after you've stopped the
2:16:14PN. This will give you a good indication
2:16:16of how the patient's body is responding.
2:16:18The next complication is infections. It
2:16:20can arise due to several reasons. Due to
2:16:22poor aseptic technique, catheter
2:16:24contamination, and due to contamination
2:16:26of solution. What action should the
2:16:28nurse take? Notify the healthcare
2:16:29provider is always the first step.
2:16:31Remove the catheter. If you believe it's
2:16:33the source of the infection, it needs to
2:16:35be removed immediately. Send the
2:16:36catheter tip to the laboratory for
2:16:38culture. Prepare to obtain blood
2:16:39cultures. Blood cultures will give
2:16:41further insights into the infection.
2:16:43Prepare for antibiotic administration.
2:16:45Based on the lab results, the right
2:16:46antibiotics will be administered to
2:16:48treat the infection. Next complication
2:16:50of parental nutrition is numoththorax.
2:16:53Now what is that? Well, if the catheter
2:16:56isn't placed precisely, it might
2:16:58puncture the plural space. This can be
2:17:00dangerous. So what should we do? First,
2:17:04always be vigilant. Observe the patient
2:17:06for any signs of pneumothorax. Symptoms
2:17:08might include shortness of breath or
2:17:10sharp chest pain. After placing the
2:17:12catheter, it's imperative to get a chest
2:17:14X-ray. This will help us determine
2:17:16whether the catheter is correctly
2:17:17positioned or not. And remember, never
2:17:20start the parental nutrition unless
2:17:22you're certain of two things. The
2:17:24catheter is properly placed and there's
2:17:27no sign of pneumothorax. Now, we're
2:17:29diving into the nuances of nursing
2:17:31considerations when it comes to parental
2:17:33nutrition. First and foremost, always
2:17:36double check the PN solution against the
2:17:39doctor's prescription. Does it contain
2:17:40the right components? Some hospitals
2:17:42even ask two registered nurses to
2:17:44validate the prescription. This ensures
2:17:46accuracy and safety. An important safety
2:17:49tip, never mix IV medications and blood
2:17:51with the PN line. Why? To avoid any risk
2:17:54of infections and incompatibility of
2:17:56solutions. Now, if you're drawing blood
2:17:58for testing from the central venus
2:18:00access site, here's a key thing to
2:18:02remember. Do it from a different port,
2:18:05not the one you're using for PN
2:18:06infusion. and ensure the PN has been
2:18:09stopped for a bit. This is because the
2:18:10PN solution can affect the sample
2:18:13results. Even with a central venus axis
2:18:15site, it's always good to have an
2:18:17alternate veny puncture site for the
2:18:19patient. For those patients on
2:18:20anti-coagulants, always keep an eye on
2:18:23the partial thromboplastin time and pro-
2:18:25thrombin time. Similarly, it's essential
2:18:28to regularly monitor the patients
2:18:30electrolyte albamin levels, liver and
2:18:32kidney functions, and other lab studies,
2:18:35especially when the client is on PN.
2:18:38Blood studies are typically done either
2:18:40every alternate day or three times a
2:18:42week. This is crucial for doctors to
2:18:44decide whether to continue or adjust the
2:18:46PN solution. Heads up for hypoglycemia.
2:18:49You will need to monitor blood glucose
2:18:51levels. Typically, this is done every 4
2:18:53hours because some components of the PN
2:18:55solution might spike up the sugar
2:18:57levels. A quick note on dehydrated
2:18:59patients. Don't be alarmed if you see
2:19:01their albamin levels drop right after
2:19:03starting PN. It's because we're
2:19:05restoring their hydration. And be extra
2:19:07cautious with severely malnourished
2:19:09patients. They're prone to what's called
2:19:11the refeeding syndrome, which means a
2:19:14sudden drop in their potassium,
2:19:16magnesium, and phosphate serum levels.
2:19:19Speaking of refeeding syndrome, its
2:19:21electrolyte shift can cause a range of
2:19:23problems from cardiovascular and
2:19:25respiratory issues to neurological
2:19:27problems. Watch out for symptoms like
2:19:29shallow breathing, confusion, weakness,
2:19:32or even seizures. If any of these arise,
2:19:35inform the doctor without delay. Now, if
2:19:38you notice unusual liver function
2:19:39values, it could be a sign of
2:19:41intolerance to fat emulsion or issues
2:19:44with glucose and protein metabolism. And
2:19:47just as a heads up, abnormal renal
2:19:48function could be due to an excessive
2:19:50amount of amino acids. Let's talk
2:19:53storage. PN solutions should be
2:19:54refrigerated and used within 24 hours
2:19:57from when they're prepared. And always
2:19:59remember to take them out about 30
2:20:01minutes to an hour before administering
2:20:03a cloudy or discolored PN solution. Red
2:20:06flag. Don't use it. Return it to the
2:20:09pharmacy. If you're thinking of adding
2:20:10nutrients or any substances to PN
2:20:13solutions, hold that thought. This
2:20:15should always be done in the pharmacy.
2:20:17Before we move ahead, let me take a
2:20:18quick moment to tell you something that
2:20:20could completely change your enclelex
2:20:23journey. If you're serious about passing
2:20:25the ENLEX in just one week or even
2:20:26within a month, then the smartest move
2:20:29you can make right now is to enroll in
2:20:30our complete online ENLEX crash course.
2:20:33This isn't just another course, it's a
2:20:34shortcut, a clear step-by-step road map
2:20:36that has already helped over 100,000
2:20:38nursing students pass the ENCLEX with
2:20:40confidence. And here's the most
2:20:41incredible part. Not a single student
2:20:43who completed this course has failed.
2:20:45Yes, that's a 100% passing rate. We
2:20:47built this course based entirely on the
2:20:49feedback and insights of thousands of
2:20:51nurses who've successfully cleared the
2:20:52ENCLEX in the last 5 years. That means
2:20:54we've removed all the fluff and focused
2:20:56only on what truly matters for your
2:20:57exam. Here's exactly what you'll get
2:20:59when you enroll. You'll get 100 hours of
2:21:01animated crash course content designed
2:21:02for rapid revision, 500 hours of
2:21:05comprehensive recorded lectures covering
2:21:06all the high yield topics, and access to
2:21:0810,000 real ENLEX questions to sharpen
2:21:11your test taking skills. You'll also get
2:21:12500 NextG case-based questions to
2:21:14strengthen your clinical judgment along
2:21:16with 15 fulllength practice tests that
2:21:18simulate the real enclelex experience.
2:21:20And of course, you'll receive our
2:21:22complete enclelex ebook and PDF notes,
2:21:24plus one full year of access so you can
2:21:26study at your pace on your schedule. And
2:21:27yes, we're currently offering a 70%
2:21:29discount for a very short period. Once
2:21:31the offer ends, it's gone. Thousands of
2:21:33students are enrolling in our online
2:21:34ENLEX course every month and passing the
2:21:36exam. But if you don't enroll now, you
2:21:38risk being left behind. Spots are
2:21:40filling fast and only a few seats are
2:21:41left. Visit our website to enroll now.
2:21:43Link is given in description box. Let's
2:21:45continue the video. The next topic is
2:21:48various types of tubes used in patient
2:21:50care. The board is likely to ask four to
2:21:53five questions on this topic. We'll
2:21:56cover tubes used in the respiratory,
2:21:58gastrointestinal, and urinary systems
2:22:01including the NG tube, folly's catheter,
2:22:04endotracchial tube, and tracheosttomy
2:22:07tube. Let's discuss the nasogastric
2:22:10tubes. These are medical devices used
2:22:12for intubating the stomach. They are
2:22:15inserted through the nose and extend
2:22:17into the stomach. The primary purpose of
2:22:20nasogastric tubes include decompressing
2:22:22the stomach to remove fluids or gas,
2:22:24promoting abdominal comfort, allowing
2:22:26surgical anastmosis to heal, reducing
2:22:29the risk of aspiration, administering
2:22:31medications to patients who cannot
2:22:33swallow, providing temporary nutrition
2:22:36and removing toxic substances in cases
2:22:39of poisoning. There are different types
2:22:40of nasogastric tubes. Miller Abbott
2:22:43tube. It is a specialized long double
2:22:46lumen tube designed for draining and
2:22:48decompressing the small intestine. It
2:22:50features one lumen connected to a
2:22:52balloon which is filled with a specific
2:22:54substance typically tungsten once
2:22:57positioned inside the stomach. The
2:22:59second lumen of the Miller Abbott tube
2:23:01is dedicated to both irrigation and
2:23:03drainage functions. This dual lumen
2:23:06structure allows for effective and
2:23:08simultaneous decompression and
2:23:10management of intestinal contents making
2:23:12it a valuable tool in specific
2:23:15gastrointestinal medical procedures.
2:23:17Levven tube it is a single lumen tube
2:23:20made of plastic or rubber with a solid
2:23:22tip is designed for use in the stomach.
2:23:25It can be inserted either through the
2:23:27nose or mouth. This type of nasogastric
2:23:30tube is primarily employed for draining
2:23:32fluid and gas from the stomach and it
2:23:34can be utilized for either intermittent
2:23:36suction or feeding purposes. The design
2:23:38and material of the leaven tube
2:23:40facilitate its specific function in
2:23:43gastrointestinal medical care providing
2:23:45an effective solution for stomach
2:23:47decompression and content management.
2:23:50The Sang Staken Blakemore tube. It is a
2:23:54three lumen medical device with two of
2:23:56its ports designed to inflate balloons
2:23:58in the esophagus and stomach for
2:24:00tamponade purposes. The third lumen is
2:24:03utilized for nasogastric suction. While
2:24:06this tube itself does not facilitate
2:24:08esophageal suction, an additional
2:24:09nasogastric tube can be inserted through
2:24:12the opposite nostril or the mouth. This
2:24:14additional tube is positioned to rest a
2:24:17top the esophagal balloon thereby
2:24:19enabling esophageal suction. This
2:24:22arrangement significantly reduces the
2:24:24risk of aspiration, making the Sangsten
2:24:26Blakemore tube a critical tool in
2:24:29managing certain gastrointestinal
2:24:31conditions. Salem sump tube. The Salem
2:24:34sump tube is a double lumen nasogastric
2:24:36tube featuring a small vent tube within
2:24:39a larger suction tube. This design is
2:24:41specifically intended to prevent mucosal
2:24:43suction damage. The small vent tube
2:24:46functions to regulate the pressure in
2:24:48the open eyes at the distal end of the
2:24:50tube. maintaining it at less than 25
2:24:53mmg. This careful pressure control is
2:24:56crucial for ensuring the safety and
2:24:58effectiveness of the tube in medical
2:25:00procedures, particularly in preventing
2:25:02damage to the stomach's mucosal lining
2:25:05during suction. Canour tube. It is a
2:25:07single lumen long medical tube featuring
2:25:10a small inflatable bag at its distal
2:25:12end. To inflate this bag, a special
2:25:15substance, usually tungsten, is injected
2:25:17using a needle, 21 gauge or smaller to
2:25:20prevent leakage and syringe. This unique
2:25:23design, combining the long tube with the
2:25:25inflatable tungsten filled bag, allows
2:25:28for specific medical applications,
2:25:30particularly in the gastrointestinal
2:25:32tract where precise control and
2:25:34maneuverability are essential.
2:25:37Nasogastric tubes intubation procedures.
2:25:40When inserting a nasogastric tube, it is
2:25:42essential to follow the specific
2:25:44procedures outlined by the healthc care
2:25:46facility. Begin by explaining to the
2:25:48patient what the procedure entails,
2:25:51including any potential discomfort.
2:25:52Position the patient in a high fowler's
2:25:55position, propped up with pillows for
2:25:57support. Check both nostrils and choose
2:25:59the one that seems more open for the
2:26:01insertion. Measure the tube length
2:26:03needed by running it from the patient's
2:26:05nose to their earlobe and then down to
2:26:07the zyphoid process. Mark this length on
2:26:10the tube with tape remembering the
2:26:12acronym NE X nose earlobe zyphoid
2:26:17process. If the patient is conscious and
2:26:19able to swallow, encourage them to
2:26:21swallow or sip water during the
2:26:23procedure as per your facility's
2:26:25guidelines. Lubricate the tube's tip
2:26:27with a water-soluble lubricant to ease
2:26:29insertion. Insert the tube gently into
2:26:32the nasal farnix, advancing it
2:26:34carefully. When the tube is at the back
2:26:36of the throat, indicated by the first
2:26:38black measurement mark on the tube,
2:26:41instruct the patient to swallow or sip
2:26:43water if they're able to. If resistance
2:26:45is encountered, rotate the tube slowly,
2:26:49directing it downwards toward the closer
2:26:51ear. In patients who are intubated or
2:26:54semiconscious, flex the head towards the
2:26:56chest while passing the tube. If there
2:26:59is any change in the patient's
2:27:00respiratory status during the procedure,
2:27:03immediately withdraw the tube. Once the
2:27:05tube is in place, confirm its placement
2:27:07with an abdominal X-ray. Connect the
2:27:09tube to suction, either intermittent or
2:27:12continuous, based on the prescription,
2:27:14and if the tube is intended for
2:27:16decompression. Secure the tube in place
2:27:18with adhesive tape on the patient's nose
2:27:21and gown, ensuring to check for any
2:27:23allergies to the tape. Monitor the
2:27:25patient for signs of nausea, vomiting,
2:27:27abdominal fullness, or distension, and
2:27:30keep track of the gastric output.
2:27:33Regularly check the residual volumes in
2:27:35the stomach, especially before feedings
2:27:37and administering medications. Aspirate
2:27:40and measure the stomach contents and if
2:27:42necessary, reinstate them to prevent
2:27:44excessive fluid and electrolyte loss
2:27:47unless the residual is abnormal or too
2:27:49large. Always follow the guidelines of
2:27:51your healthcare facility for these
2:27:53steps. Before administering anything
2:27:56through the tube, such as irrigation
2:27:58solutions, feedings, or medications,
2:28:00aspirate stomach contents and check
2:28:03their pH to ensure the tube is correctly
2:28:05positioned in the stomach. Use normal
2:28:07saline for irrigation if needed, and
2:28:10always follow your facility's guidelines
2:28:12for this. Pay attention to the patients
2:28:14fluid and electrolyte balance and advise
2:28:17them on how to move to avoid nasal
2:28:19irritation and dislodging the tube.
2:28:21Daily remove the adhesive tape. Clean
2:28:24and dry the skin around the nose to
2:28:26check for any irritation or damage and
2:28:28then reapply fresh tape. Nasogastric
2:28:30tube irrigation. To irrigate a
2:28:32nasogastric tube effectively and safely,
2:28:35start by confirming the tube's
2:28:37placement. Regular irrigation, typically
2:28:39every 4 hours, is crucial for assessing
2:28:42and maintaining the tube's patency. For
2:28:44the irrigation process, gently instill
2:28:4630 to 50 ml of water or normal saline,
2:28:50depending on your healthcare facility's
2:28:51policy using an irrigation syringe.
2:28:54After instilling the fluid, use the
2:28:56syringe plunger to withdraw the fluid.
2:28:58This step helps in checking the patency
2:29:00of the tube. If you notice that the tube
2:29:02flow is sluggish, repeat the process to
2:29:05ensure the tube remains clear and
2:29:07functional. When it comes time to remove
2:29:09the nasogastric tube, instruct the
2:29:11patient to take a deep breath and hold
2:29:14it. Then slowly and steadily remove the
2:29:17tube over a period of 3 to 6 seconds.
2:29:20It's helpful to coil the tube around
2:29:22your hand as you remove it, allowing for
2:29:24a controlled and smooth withdrawal.
2:29:27Gastrointestinal tube feedings.
2:29:29Administering feedings through a
2:29:30nasogastric tube involves several
2:29:32careful steps. First, verify the
2:29:35healthcare provers's prescription and
2:29:37your facilities policy regarding
2:29:38residual stomach contents. Typically, if
2:29:41the residual volume is less than 100
2:29:43milliliters, you can proceed with the
2:29:45feeding. Be cautious as large volume
2:29:48aspirates may indicate delayed gastric
2:29:50emptying, increasing the risk of
2:29:52aspiration. Before feeding, assess the
2:29:55patients bowel sounds. If you do not
2:29:57detect any bowel sounds, hold off on the
2:29:59feeding and inform the healthcare
2:30:01provider. When positioning the patient,
2:30:03use a high fowler's position for alert
2:30:06patients or if the patient is
2:30:08comeomaosse, place them in a high
2:30:10fowler's position and on their right
2:30:12side. Next, check the tube placement by
2:30:14aspirating gastric contents and
2:30:16measuring their pH, which should be 3.5
2:30:19or lower. Aspirate all stomach contents
2:30:21to measure the residual volume.
2:30:23Typically, you should return these
2:30:25contents to the stomach to avoid
2:30:27electrolyte imbalances unless the color
2:30:29or characteristics are abnormal or the
2:30:32volume exceeds 250 ml. Before
2:30:36administering the feeding, warm it to
2:30:38room temperature to prevent discomfort
2:30:40such as diarrhea and cramps. For
2:30:42continuous or cyclic feedings, use an
2:30:44infusion feeding pump. In the case of
2:30:47bolus feeding, keep the patient in a
2:30:49high fowler's position for at least 30
2:30:51minutes postfeeding. Either use an
2:30:53infusion pump or allow the feeding to
2:30:55infuse via gravity, but avoid using
2:30:58force to plunge the feeding into the
2:31:00stomach. Finally, for continuous
2:31:02feeding, ensure the patient remains in a
2:31:04semiferous position at all times to
2:31:07facilitate digestion and reduce the risk
2:31:10of aspiration. Before administrating any
2:31:12solutions through a gastrointestinal
2:31:14tube, including feeding solutions,
2:31:16medications, or other substances, always
2:31:19assess the tube's placement. Incorrect
2:31:22placement can significantly increase the
2:31:24risk of aspiration in the patient.
2:31:26Regularly assess the patients bowel
2:31:28sounds and refrain from administrating
2:31:30feedings if bowel sounds are absent as
2:31:33this could indicate a problem with
2:31:35gastrointestinal motility or function.
2:31:37Administer the feeding at the prescribed
2:31:39rate or for intermittent bless feedings
2:31:42use gravity flow. Employ a 50 to 60 ml
2:31:46syringe with a plunger removed for this
2:31:48purpose. For maintaining hygiene and
2:31:50safety, change the feeding container and
2:31:52tubing every 24 hours or as per your
2:31:55healthcare facility's policy. To prevent
2:31:57bacterial growth, avoid hanging more
2:32:00feeding solution than needed for a
2:32:024-hour period. Always check the
2:32:03expiration date of the formula before
2:32:06use. Shake the formula thoroughly before
2:32:09pouring it into the feeding container,
2:32:11such as a feeding bag. Some feeding
2:32:12solutions use bags for adding formula,
2:32:15while others use bottles that directly
2:32:17connect to the feeding tube. Note that
2:32:19some tubing may have a Y-sight
2:32:21connection, allowing for regular
2:32:23flushing programmed through the pump
2:32:25instead of manually through a piston
2:32:27syringe. After each feeding, gently
2:32:29flush the tube with 30 to 50 ml of water
2:32:32or normal saline using an irrigation
2:32:35syringe. This step helps in maintaining
2:32:37the patency of the tube and reduces the
2:32:39risk of blockages. Now we will discuss
2:32:42about gastric and esophageal tubes.
2:32:44Esophageal and gastric tubes are
2:32:46specialized medical devices with
2:32:49specific applications and precautions.
2:32:51Their primary use is to control bleeding
2:32:54in the esophagus, particularly from
2:32:56bleeding veins that other interventions
2:32:58can't manage or are contraindicted.
2:33:01However, they should not be used in
2:33:03patients with esophageal ulceration,
2:33:06necrosis, or previous esophageal surgery
2:33:09due to the risk of rupture. There are
2:33:11two main types of these tubes. The
2:33:14Sangsten Blakemore tube and the
2:33:16Minnesota tube. The Sangsten Blakemore
2:33:18tube, which is less commonly used, is a
2:33:20triple lumen gastric tube featuring an
2:33:23inflatable esophageal balloon to
2:33:25compress esophageal varices, an
2:33:27inflatable gastric balloon for pressure
2:33:29at the cardio esophageal junction and a
2:33:32lumen for gastric aspiration. Alongside
2:33:36this, a nasogastric tube is inserted in
2:33:38the opposite nostril to collect
2:33:40secretions above the esophageal balloon.
2:33:43The Minnesota tube more frequently used
2:33:45is a variation of the Sangston Blakemore
2:33:48tube with an additional lumen making it
2:33:51a 4 lumen gastric tube. This extra lumen
2:33:54is for aspirating esophagal secretions.
2:33:57The correct placement of these tubes is
2:33:59confirmed via radiography of the upper
2:34:02abdomen and chest. In terms of
2:34:04interventions, there are several
2:34:06important steps and precautions. Before
2:34:08insertion, the patency and integrity of
2:34:11all balloons must be checked. Each lumen
2:34:14should be clearly labeled. The client is
2:34:16placed in an upright or fowler's
2:34:18position for the insertion. Immediately
2:34:20after insertion, radiography is
2:34:22conducted to verify the placement. The
2:34:25patient's head should be kept elevated
2:34:27once the tube is in place. The balloon
2:34:29ports are double clamped to prevent air
2:34:31leaks and scissors should be kept at the
2:34:34bedside to quickly deflate the balloons
2:34:36in case of respiratory distress. To
2:34:38avoid esophageal ulceration or necrosis,
2:34:41esophageal pressure should be released
2:34:43at intervals as prescribed and in
2:34:46accordance with agency policy.
2:34:48Monitoring for increased bloody drainage
2:34:50is crucial as it may indicate ongoing
2:34:53bleeding and rupture of the varies.
2:34:55Additionally, signs of esophageal
2:34:57rupture such as a drop in blood
2:34:59pressure, increased heart rate, and back
2:35:02and upper abdominal pain are medical
2:35:04emergencies and must be reported
2:35:07immediately. Now, we will read about
2:35:09lavage tubes. Lavage tubes are medical
2:35:12devices designed to remove toxic
2:35:14substances from the stomach. They come
2:35:16in different types, each with specific
2:35:19features and functions. One type of
2:35:21lavage tube is a lava curator. This
2:35:24orogastric tube has a large suction
2:35:26lumen and a smaller lavage vent lumen.
2:35:29The design of the lava curator allows
2:35:31for continuous suction. The irrigation
2:35:33solution enters through the lavage lumen
2:35:36while the stomach contents are
2:35:38simultaneously removed through the
2:35:40suction lumen. This dual lumen system
2:35:42facilitates efficient and effective
2:35:45stomach cleansing. Another type of
2:35:47lavage tube is the ewalt tube. This is a
2:35:50single lumen large tube primarily used
2:35:52for rapid one-time irrigation and
2:35:55evacuation. The EWall tube's design and
2:35:57size make it suitable for situations
2:35:59where quick and thorough stomach
2:36:01evacuation is necessary such as in cases
2:36:04of acute poisoning or overdose where
2:36:06immediate removal of toxic substances
2:36:08from the stomach is crucial. Both types
2:36:10of tubes are vital tools in medical
2:36:12emergencies involving the ingestion of
2:36:15toxic substances, allowing health care
2:36:17professionals to rapidly and effectively
2:36:19cleanse the stomach to reduce the
2:36:21absorption and systematic effects of the
2:36:24ingested toxins. Before we move ahead,
2:36:26let me take a quick moment to tell you
2:36:27something that could completely change
2:36:30your enclelex journey. If you're serious
2:36:32about passing the ENCLEX in just one
2:36:34week or even within a month, then the
2:36:36smartest move you can make right now is
2:36:37to enroll in our complete online ENLEX
2:36:40crash course. This isn't just another
2:36:41course, it's a shortcut. A clear
2:36:43step-by-step road map that has already
2:36:45helped over 100,000 nursing students
2:36:46pass the ENCLEX with confidence. And
2:36:48here's the most incredible part. Not a
2:36:50single student who completed this course
2:36:52has failed. Yes, that's a 100% passing
2:36:54rate. We built this course based
2:36:56entirely on the feedback and insights of
2:36:58thousands of nurses who've successfully
2:36:59cleared the enollex in the last 5 years.
2:37:02That means we've removed all the fluff
2:37:03and focused only on what truly matters
2:37:05for your exam. Here's exactly what
2:37:06you'll get when you enroll. You'll get
2:37:08100 hours of animated crash course
2:37:09content designed for rapid revision, 500
2:37:12hours of comprehensive recorded lectures
2:37:14covering all the high yield topics, and
2:37:15access to 10,000 real and clelex
2:37:17questions to sharpen your test taking
2:37:19skills. You'll also get 500 nextgen
2:37:21case-based questions to strengthen your
2:37:22clinical judgment along with 15
2:37:24fulllength practice tests that simulate
2:37:26the real enclelex experience. And of
2:37:28course, you'll receive our complete
2:37:30Enclelex ebook and PDF notes, plus one
2:37:32full year of access so you can study at
2:37:34your pace on your schedule. And yes,
2:37:35we're currently offering a 70% discount
2:37:37for a very short period. Once the offer
2:37:39ends, it's gone. Thousands of students
2:37:41are enrolling in our online ENLEX course
2:37:43every month and passing the exam. But if
2:37:44you don't enroll now, you risk being
2:37:46left behind. Spots are filling fast and
2:37:48only a few seats are left. Visit our
2:37:50website to enroll now. Link is given in
2:37:51description box. Let's continue the
2:37:53video. Next topic is urinary and renal
2:37:56tubes. The topic of urinary and renal
2:37:59tubes primarily focuses on the types of
2:38:01urinary catheters and the routine care
2:38:03associated with them. Types of urinary
2:38:06catheterss. Single lumen catheters.
2:38:09These are typically used for straight
2:38:11caization which involves emptying the
2:38:13bladder, obtaining sterile urine
2:38:15specimens and measuring the residual
2:38:18urine after avoiding. Double lumen
2:38:20catheters. These are employed when
2:38:22continuous bladder drainage is
2:38:24necessary. One of the lumens is used for
2:38:26drainage while the other is for
2:38:28inflating a balloon that helps keep the
2:38:30catheter in place. Triple lumen
2:38:32catheters these are used for both
2:38:35bladder irrigation and drainage. Among
2:38:37the three lumens, one is for instilling
2:38:40the bladder irrigant solution, another
2:38:42for continuous bladder drainage and the
2:38:44third for balloon inflation. It is
2:38:47crucial to employ strict aseptic
2:38:50techniques during the insertion and care
2:38:52of these catheters to prevent
2:38:54infections. Routine urinary catheter
2:38:57care. Personal protective measures like
2:38:59wearing gloves should be taken and the
2:39:01penal area needs to be cleaned with warm
2:39:04soapy water. For proper cleaning, the
2:39:06labia or foreskin should be retracted to
2:39:09expose the miatus. In adult males, the
2:39:11foreskin should be returned to its
2:39:14normal position afterward. The catheter
2:39:16itself should be cleaned along its
2:39:18length with soap and water to prevent
2:39:19tugging or injury. The catheter should
2:39:22be anchored to the thigh. The catheter
2:39:24bag which collects urine must always be
2:39:26kept below the level of the bladder to
2:39:28ensure proper drainage and to prevent
2:39:31backflow which could lead to infection.
2:39:33Now we will discuss urinary catheters
2:39:36insertion procedures. To explain the
2:39:38urinary caization procedure and its
2:39:40potential discomfort to the client,
2:39:42follow these steps. Prepare the client
2:39:44for the procedure, explaining each step
2:39:47to ensure they understand and are
2:39:49comfortable. Discuss any discomfort they
2:39:51might experience, such as a sensation of
2:39:53pressure or slight discomfort during the
2:39:55insertion of the catheter. Position the
2:39:57client appropriately. For females,
2:40:00assist them into a dorsal recumbent
2:40:02position. lying on their back with knees
2:40:04flexed. Use pillows to support their
2:40:06legs, reducing muscle tension and
2:40:08enhancing comfort. For males, assist
2:40:10them into a supine position with their
2:40:13thighs slightly abducted. Prior to the
2:40:15procedure, wear clean gloves and wash
2:40:17the paranal area with soap and water as
2:40:19needed, ensuring it's dry afterwards.
2:40:22Dispose of the gloves and perform hand
2:40:24hygiene. Open the catheter kit
2:40:26carefully, keeping in mind that all
2:40:28components inside are sterile. Arrange
2:40:30the supplies in order of use. Place a
2:40:33waterproof sterile drape under the
2:40:35client's buttocks with the plastic side
2:40:37facing down. Adhere to sterile
2:40:39techniques throughout the procedure. Put
2:40:41on sterile gloves without contaminating
2:40:43them. Use a fenistrated drape to expose
2:40:46the necessary area, either the labia or
2:40:48penis without touching any non-sterile
2:40:51surface. Lubricate the catheter
2:40:53appropriately. For females, 2.5 to 5 cm,
2:40:581 to 2 in. and for males 12.5 to 17.5 cm
2:41:035 to 7 in. Attach a pre-filled syringe
2:41:06to the balloon port and prepare cotton
2:41:08balls or swab sticks for cleansing the
2:41:11area. Maintain sterility by keeping the
2:41:13sterile field and gloved hands above
2:41:15waist level. Be mindful that the 1-in
2:41:18border on the sterile field is
2:41:20considered contaminated. For catheter
2:41:22insertion in females, position the
2:41:24client in a dorsal recumbent position
2:41:26with legs open for full visualization.
2:41:29With a non-dormant hand, expose the
2:41:32urethal miatus by spreading the labia
2:41:34and using sterilized cotton balls or
2:41:36swab sticks to clean the area. Advance
2:41:38the catheter gently until urine flows.
2:41:41Then a bit further. For catheter
2:41:43insertion in males, positioning the
2:41:46penis perpendicular to the body, clean
2:41:48it with antiseptic soaked cotton balls
2:41:51or swab sticks, insert the catheter
2:41:53while lifting the penis and apply light
2:41:55traction. Advance the catheter until
2:41:57urine flows, then a bit further. Inflate
2:42:00the catheter balloon as per the
2:42:02manufacturer's instructions and gently
2:42:04pull back until resistance is felt.
2:42:06Secure the catheter tubing to the inner
2:42:08thigh using an approved securing device.
2:42:11Documents all relevant details of the
2:42:13procedure, including the type and size
2:42:15of catheter, the amount of fluid used
2:42:18for the balloon, urine characteristics,
2:42:20any specimen collected, the client's
2:42:22response, and confirm that educational
2:42:25instructions were provided. Now, let's
2:42:28move to urinary catheters removal
2:42:30procedure. To remove a urinary catheter,
2:42:32begin the process by explaining to the
2:42:34patient what the procedure entails,
2:42:37including any potential discomfort they
2:42:39may experience. Position the patient in
2:42:41the same manner as they were during the
2:42:43caization. For female patients, place a
2:42:46towel between their thighs and for male
2:42:48patients, position it over their thighs.
2:42:51This step is followed by the removal of
2:42:53the securing device. Next, use a 10ml
2:42:56syringe to access the balloon injection
2:42:58port. Carefully and slowly withdraw all
2:43:01the solution from the balloon to ensure
2:43:03it is completely deflated. Inform the
2:43:06patient that they might feel a burning
2:43:07sensation during the catheter's
2:43:09withdrawal. It's crucial to pull the
2:43:11catheter out in a smooth and slow manner
2:43:13to minimize discomfort. After the
2:43:15catheter has been removed, closely
2:43:18monitor the patients urinary function.
2:43:20This includes observing and documenting
2:43:22the first instance of voiding post
2:43:24removal. Continue to record the time and
2:43:27amount of urine voided over the next 24
2:43:29hours. This documentation is important
2:43:31to ensure that the patients urinary
2:43:33function has returned to normal
2:43:35following the removal of the catheter.
2:43:37The next topic is endotracchial tubes.
2:43:40Endotracchial tubes are essential
2:43:42medical devices designed to maintain a
2:43:44patient's airway. Their primary use is
2:43:46in scenarios where a patient requires
2:43:48mechanical ventilation. In cases where a
2:43:51patient needs an artificial airway for
2:43:53an extended period, typically beyond 10
2:43:55to 14 days, a tracheosttomy is often
2:43:58performed. coast in this procedure is
2:44:00preferred to avoid potential mucosal and
2:44:03vocal cord damage that prolonged use of
2:44:05an endotracchial tube can cause. A
2:44:08crucial component of the endotrachial
2:44:10tube is the cuff located at its distal
2:44:13end. When inflated, this cuff creates a
2:44:16seal between the trachea and itself.
2:44:19This seal is vital for multiple reasons.
2:44:22It prevents the aspiration of fluids
2:44:24into the lungs and ensures that a set
2:44:26tidal volume is delivered during
2:44:28mechanical ventilation. Additionally, an
2:44:30inflated cuff blocks air from reaching
2:44:33the vocal cords, nose or mouth. Another
2:44:36important feature of the endotraal tube
2:44:38is the pilot balloon. This component
2:44:40allows for the insertion of air into the
2:44:42cuff and helps to prevent air from
2:44:44escaping. It also serves as an indicator
2:44:47for the presence or absence of air in
2:44:49the cuff which is crucial for the proper
2:44:51functioning of the tube. Lastly, the
2:44:54endotracheial tube includes a universal
2:44:56adapter. This adapter is a key element
2:44:59as it enables the connection of the tube
2:45:01to mechanical ventilation tubing or
2:45:03other types of oxygen delivery systems.
2:45:06This versatility is essential in a
2:45:08clinical setting where the needs for
2:45:10oxygen delivery can vary greatly
2:45:12depending on the patient's condition.
2:45:14Interventions for ensuring proper
2:45:16placement and management of an
2:45:17endotracial tube include several key
2:45:20steps. First, the placement of the tube
2:45:23is confirmed by chest X-ray, ensuring it
2:45:26is positioned one to 2 cm above the
2:45:28corina. Next, placement is assessed by
2:45:31oscalating both sides of the chest while
2:45:34manually ventilating with a
2:45:35resuscitation bag. This step is crucial
2:45:38to confirm that breath sounds and chest
2:45:40wall movement are not absent on the left
2:45:43side which could indicate that the tube
2:45:45is in the right main stem bronchus.
2:45:48Additionally, oscultation over the
2:45:50stomach is performed to rule out
2:45:52esophageal intubation. If the tube is
2:45:55mistakenly placed in the stomach, breath
2:45:57sounds will be louder over the stomach
2:45:59than the chest and abdominal distension
2:46:02will be present. After confirming
2:46:04correct placement, the tube should be
2:46:06secured immediately with adhesive tape.
2:46:08Monitoring the position of the tube at
2:46:10the lip or nose is also essential along
2:46:13with regular checks on the patients skin
2:46:15and mucous membranes. Suctioning of the
2:46:17tube is advised only when necessary.
2:46:20Furthermore, it's important to move the
2:46:22oral tube to the opposite side of the
2:46:24mouth daily. This practice prevents
2:46:26pressure and necrosis of the lips and
2:46:28mouth area, avoids nerve damage, and
2:46:31facilitates inspection and cleaning of
2:46:33the mouth. Moving the tube should be a
2:46:35task performed by two health care
2:46:37professionals to ensure safety and
2:46:39accuracy. To ensure the stability of an
2:46:42endotracheial or tracheosttomy tube,
2:46:45it's crucial to prevent its
2:46:46dislodgement. Activities such as
2:46:48suction, coughing, and speaking attempts
2:46:50can place additional stress on the tube,
2:46:53increasing the risk of it becoming
2:46:54dislodged. Regularly assess the pilot
2:46:56balloon to confirm that the cuff is
2:46:58properly inflated. Maintaining cuff
2:47:00inflation is vital as it creates a seal,
2:47:03allowing for complete mechanical control
2:47:05of respiration. Monitoring cuff
2:47:07pressures is also an essential aspect of
2:47:10care. This should be done at least every
2:47:128 hours or as specified by the
2:47:15healthcare facilities procedures to
2:47:17ensure pressures do not exceed 20 mmg.
2:47:21An anoid pressure monometer is typically
2:47:23used for measuring cuff pressures
2:47:25employing minimal leak and occlusive
2:47:27techniques when inflating the cuff helps
2:47:29in accurately checking these pressures.
2:47:32Moreover, always keep a resuscitation
2:47:34ambu bag readily available at the
2:47:36bedside of a patient with an
2:47:38endotracchial or tracheosttomy tube.
2:47:41This is a critical safety measure to
2:47:44provide immediate respiratory support if
2:47:46needed. Now let's discuss the extation
2:47:49procedure of endotracchial tubes. The
2:47:51process of extation which involves the
2:47:54removal of an endotrachial tube is a
2:47:57critical procedure in patient care. It
2:47:59begins by hyper oxygenating the patient
2:48:02and suctioning both the endotracchial
2:48:04tube and the oral cavity. This step is
2:48:07vital for ensuring that the patients
2:48:09lungs are well oxygenated and free of
2:48:11secretions before the tube is removed.
2:48:14Next, the patient is positioned in a
2:48:16semifouers position. This semi-upright
2:48:19position helps in easing breathing and
2:48:21is preferred posture for respiratory
2:48:23comfort. Following this, the cuff of the
2:48:25endotrachial tube is deflated. As the
2:48:28cuff deflates, the patient is asked to
2:48:30inhale deeply. At the peak of their
2:48:32inhalation, the tube is removed. During
2:48:35this removal, suctioning of the airway
2:48:37through the tube is performed
2:48:39simultaneously, which helps in clearing
2:48:41out any residual secretions. After the
2:48:44tube is out, the patient is instructed
2:48:46to cough and take deep breaths. This
2:48:48practice is essential for helping to
2:48:50clear any accumulated secretions in the
2:48:52throat that may have built up during the
2:48:55time the tube was in place. Oxygen
2:48:57therapy is then applied as prescribed.
2:49:00This step ensures that the patient
2:49:02continues to receive adequate oxygen
2:49:04post extation, especially since the
2:49:06respiratory system may still be
2:49:08adjusting to the removal of the tube.
2:49:10Close monitoring for any respiratory
2:49:12difficulty is crucial after extation. If
2:49:16any signs of respiratory distress are
2:49:18observed, it's imperative to contact the
2:49:20healthcare provider immediately. Lastly,
2:49:23patients are informed that experiencing
2:49:25horarsseness or a sore throat is normal
2:49:28after exubation. They are advised to
2:49:30limit speaking if they experience these
2:49:32symptoms, allowing their throat some
2:49:34time to recover from the irritation
2:49:36caused by the tube. The next topic is
2:49:38trachosttomy tubes. Trachosttomy is a
2:49:41medical procedure that involves
2:49:42surgically creating an opening directly
2:49:45into the trachea to establish an airway.
2:49:47This typically involves inserting a
2:49:49tracheosttomy tube into the opening
2:49:51which can be connected to a mechanical
2:49:53ventilator or other types of oxygen
2:49:55delivery devices. The procedure can be
2:49:58either temporary or permanent with
2:50:00various types of tracheosttomy tubes
2:50:02available. Ensuring the procedure
2:50:04success and the patients safety involves
2:50:06several crucial interventions. Regular
2:50:09assessments of the patients breathing
2:50:11and checking for bilateral breath sounds
2:50:13are essential. Monitoring arterial blood
2:50:15gases and pulse oxymmetry is important
2:50:18to evaluate the patients oxygen levels
2:50:20and respiratory status. Encouraging the
2:50:22patient to cough and breathe deeply is
2:50:25vital in maintaining clear airways.
2:50:27Keeping the patient in a semifallers or
2:50:29high fowlers position can significantly
2:50:31improve breathing. Monitoring for signs
2:50:33of bleeding, difficulty breathing,
2:50:36absence of breath sounds or crepitus is
2:50:38crucial as these may indicate
2:50:40complications like hemorrhage or
2:50:42pneumothorax.
2:50:44Administering prescribed respiratory
2:50:46treatments and suctioning fluids as
2:50:48necessary including pre-suctioning hyper
2:50:51oxygenation are part of routine care. If
2:50:54the patient is eating, it is important
2:50:56to sit them up during meals and take
2:50:58precautions to prevent aspiration.
2:51:00Monitoring and maintaining cuff
2:51:02pressures as prescribed ensures the
2:51:04tracheosttomy tube functions correctly.
2:51:06Regular assessment of the sto and
2:51:08secretions for signs of blood or
2:51:10infection is necessary. Cleaning the
2:51:12tracheosttomy site and inner canula
2:51:14according to healthcare provider
2:51:16instructions and agency policy often
2:51:18using half strength hydrogen peroxide is
2:51:21important. Providing humidified oxygen
2:51:23is necessary because the normal
2:51:25humidification process is bypassed in
2:51:27patients with a tracheosttomy. Carefully
2:51:29changing tracheosttomy ties with
2:51:31assistance ensures the safety and
2:51:33comfort of the patient. Keeping
2:51:35emergency equipment like a resuscitation
2:51:37bag, obtuitor, clamps, and a spare
2:51:40tracheosttomy tube of the same size at
2:51:42the bedside is crucial for immediate
2:51:44response to any complications. It's
2:51:46important to note that a plug should
2:51:49never be inserted into a tracheiotomy
2:51:51tube until the cuff is deflated and the
2:51:54inner canula is removed. Inserting a
2:51:56plug without taking these precautions
2:51:58can prevent air flow and pose serious
2:52:00risks to the patient. Types of
2:52:02tracheosttomy tubes. Tracheosttomy tubes
2:52:05come in various types, each designed for
2:52:07specific clinical needs. Whether it's
2:52:10maintaining an open airway, facilitating
2:52:12mechanical ventilation, or aiding in the
2:52:15gradual transition to natural breathing.
2:52:17Here's an overview of some common types.
2:52:19Double lumen tube. This tube features
2:52:21two main parts. The outer canula that
2:52:24fits into the sto maintaining the
2:52:26airways openness. Attached to it is a
2:52:29face plate which indicates the tube size
2:52:31and type and has small holes on either
2:52:34side for securing the tubes with ties.
2:52:37The inner canula which snugly fits into
2:52:39the outer canula and locks into place.
2:52:42This part is crucial for connecting to
2:52:44respiratory therapy equipment like
2:52:46ventilators. Some inner canulas are
2:52:48reusable after cleaning while others are
2:52:51disposable. An opterator is also part of
2:52:54the setup, aiding in the tube's
2:52:55insertion by guiding its direction. It
2:52:58is removed after the tube is placed but
2:53:00kept nearby for emergencies. The cuff,
2:53:03another key component, inflates to seal
2:53:05the airway. Useful in mechanical
2:53:07ventilation or to prevent aspiration
2:53:09during tube feeding. Single lumen tube.
2:53:12This tube is similar to the double lumen
2:53:14variant but lacks an inner canula. It
2:53:16requires more intensive nursing care due
2:53:18to the absence of an inner canula to
2:53:20maintain a clear lumen. Fenistrated
2:53:22tube. This tube is designed with a
2:53:24precut opening or fenestration in the
2:53:27outer canula's upper posterior wall.
2:53:29It's used to gradually wean patients
2:53:31from tracheosttomy allowing them to
2:53:33breathe through their natural airway and
2:53:35enabling speech. Cuffed fenistrated
2:53:38tube. This tube is ideal for patients
2:53:39who need both mechanical ventilation and
2:53:41the ability to speak such as those with
2:53:44spinal cord paralysis or neuromuscular
2:53:46diseases. This tube allows for
2:53:48ventilation when needed and when the
2:53:49ventilator is not in use, the cuff can
2:53:51be deflated and the tube capped to
2:53:53enable speech. However, it's not
2:53:56recommended for weaning from a
2:53:57tracheosttomy as the deflated cuff might
2:54:00still partially obstruct the airway.
2:54:02Complications of a tracheosttomy.
2:54:05Complications related to tracheal tubes
2:54:07can include various conditions such as
2:54:09tube obstruction and dislodgement.
2:54:11Trachomacia a condition where constant
2:54:14pressure from the cuff of the tube leads
2:54:16to tracheal dilation and erosion of the
2:54:18cartilage is one such complication.
2:54:21Another issue is tracheal stenosis which
2:54:24occurs when the tracheal lumen narrows
2:54:26due to scar formation. This scarring
2:54:28results from irritation of the tracheal
2:54:30mucosa caused by the cuff of the tube.
2:54:33Tracho esophageal fistula TEF is another
2:54:37serious complication. It arises when
2:54:39excessive cuff pressure erodess the
2:54:41posterior wall of the trachea leading to
2:54:44the formation of a hole between the
2:54:46trachea and the anterior esophagus.
2:54:48Patients with a nasogastric tube present
2:54:50are at the highest risk for this
2:54:52condition. Additionally, there's the
2:54:55risk of a trachea enominate artery
2:54:57fistula. This condition occurs when a
2:55:00malposition tube pushes its distal tip
2:55:03against the lateral wall of the trachea.
2:55:05Continued pressure can lead to necrosis
2:55:07and erosion of the enominant artery,
2:55:10making this a medical emergency. Before
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2:56:40video. Welcome to the next episode of
2:56:43our ENLEX review series. In this
2:56:46episode, we're going to dive deep into
2:56:48the essential topics of obstetrics and
2:56:51gynecology, which the ENLEX board
2:56:53frequently tests you on. Don't forget to
2:56:55hit that subscribe button as we have
2:56:58over 100 more videos planned to assist
2:57:01you in acing your ENLEX exam. The
2:57:03gastation period. The gestation period,
2:57:06often referred to as pregnancy, marks
2:57:09the remarkable journey from the
2:57:10fertilization of the OAM to the eagerly
2:57:13anticipated due date. This period
2:57:15typically encompasses around 280 days,
2:57:18but it is essential to recognize that it
2:57:21can vary significantly among
2:57:22individuals. One method employed to
2:57:24estimate the due date is Nagel's rule.
2:57:27To apply this rule, a woman should have
2:57:29a regular 28-day menstrual cycle.
2:57:31Nagel's rule involves subtracting 3
2:57:33months and adding 7 days to the first
2:57:36day of the last menstrual period with an
2:57:40additional year added if necessary.
2:57:42Alternatively, one can add 7 days to the
2:57:45last menstrual period and count forward
2:57:479 months. Gravidity and parody.
2:57:49Gravidity and parody are terms that
2:57:51provide insight into a woman's
2:57:53reproductive history. Gravidity pertains
2:57:56to the number of pregnancies a woman has
2:57:58experienced, including her current one.
2:58:00A pregnant woman is referred to as a
2:58:02gravita. A noly gravita is a woman who
2:58:04has never been pregnant while a preema
2:58:07gravita is embarking on her first
2:58:09pregnancy journey. And a multigravita
2:58:11has been pregnant at least once before.
2:58:13Parody on the other hand quantifies the
2:58:16number of live births a woman has had
2:58:18after reaching a gastational age of at
2:58:20least 20 weeks. Regardless of whether
2:58:23the infant was born alive or not, a null
2:58:26parah has not given birth beyond 20
2:58:28weeks of gastation. A preeipara has
2:58:31experienced one such birth and a
2:58:33multipara has experienced two or more
2:58:36pregnancies that reach the stage of
2:58:38fetal viability. To encapsulate this
2:58:40information, health care professionals
2:58:42often use the GTP
2:58:44acronym. G represents gravidity, the
2:58:48total number of pregnancies. T stands
2:58:50for term births, babies born after 36
2:58:53weeks of gastation. P refers to pre-term
2:58:57births. Babies born before 37 weeks of
2:59:00gastation. A indicates abortions or
2:59:03miscarriages counted in gravida if
2:59:06before 20 weeks of gastation and in
2:59:08parody if past 20 weeks of gastation. L
2:59:11signifies the number of currently living
2:59:14children. Recognizing pregnancy signs.
2:59:16Pregnancy is a transformative phase
2:59:18marked by a myriad of signs and symptoms
2:59:21characterized as presumptive, probable,
2:59:24and positive signs. Presumptive signs
2:59:27are subjective indicators experienced by
2:59:29the mother, including amenorhea, nausea,
2:59:33vomiting, breast changes, urinary
2:59:35frequency, quickening, the first
2:59:37perception of fetal movement, fatigue,
2:59:40and alterations in vaginal mucosa color.
2:59:42Probable signs are objective findings
2:59:45that can be observed by a health care
2:59:46provider such as uterine enlargement.
2:59:49Hegger's sign softening of the lower
2:59:51uterine segment. Good old sign,
2:59:53softening of the cervix, Chadwick's
2:59:55sign, violet colorization of mucous
2:59:58membranes, aotment, fetal rebound on
3:00:00palpitation, Braxton Hicks contractions,
3:00:03and a positive pregnancy test that
3:00:05detects human corionic gonadotropen.
3:00:07Positive signs are diagnostic and
3:00:10confirm the presence of pregnancy. These
3:00:12signs include detecting the fetal
3:00:14heartbeat using electronic devices like
3:00:17a Doppler transducer at 10 to 12 weeks
3:00:19or a non electronic fettocope at 20
3:00:22weeks, feeling active fetal movements,
3:00:25and visualizing the fetus through
3:00:27radiography or ultraography.
3:00:30Fundle height. Measuring funal height is
3:00:32a valuable technique for evaluating the
3:00:34gastational age of the fetus during
3:00:36pregnancy. In the second and third
3:00:38trimesters, weeks 18 to 30, the funal
3:00:41height in centime approximately
3:00:43corresponds to the fetal age in weeks
3:00:45minus 2 cm. For instance, at 20 weeks of
3:00:49pregnancy, the fundus should be
3:00:51positioned near the level of the
3:00:53umbilicus. At 16 weeks, the fundus is
3:00:55typically located midway between the
3:00:58symphysis pubis and the umbilicus, while
3:01:00at 36 weeks, it should reach the zyoid
3:01:04process. It is crucial to exercise
3:01:06caution during funal height assessments
3:01:08particularly when the client is in the
3:01:10supine position as it can lead to supine
3:01:13hypotension. The physiological
3:01:15transformation of the maternal body.
3:01:17Pregnancy instigates a profound array of
3:01:20physiological changes within a woman's
3:01:22body subject to variation among
3:01:24individuals and influenced by cultural
3:01:26factors. Here are key physiological
3:01:29alterations that transpire in the
3:01:31cardiovascular system. Pregnancy induces
3:01:34several adjustments. Circulating blood
3:01:36volume increases, encompassing elevation
3:01:39in both plasma and total red blood cell
3:01:42volume. This shift can result in
3:01:44physiological anemia as plasma increase
3:01:46surpasses red blood cell production.
3:01:48Consequently, iron requirements escalate
3:01:51during pregnancy. Furthermore, the heart
3:01:53enlarges and shifts slightly upward and
3:01:56to the left due to the expanding uterus.
3:01:58Additionally, sodium and water retention
3:02:00may occur as part of these
3:02:02cardiovascular adaptations. Turning to
3:02:05the respiratory system, pregnancy brings
3:02:07about notable changes. Oxygen
3:02:09consumption rises by approximately 15 to
3:02:1120%. The enlarging uterus exerts
3:02:14pressure on the diaphragm, pushing it
3:02:16upward, potentially causing shortness of
3:02:18breath in some women. Pulse rate may
3:02:20also increase by 10 to 15 beats per
3:02:23minute while blood pressure under goes a
3:02:25slight decrease in the second trimester
3:02:27before rising in the third trimester.
3:02:30Respiratory rate however mostly remains
3:02:32stable or slightly increases in the
3:02:34gastrointestinal system. Pregnant women
3:02:37experience distinct alterizations.
3:02:39Nausea and vomiting are common in early
3:02:41pregnancy due to the secretion of human
3:02:44corionic gonadotropen. Although these
3:02:46symptoms typically subside by the third
3:02:48month, decreased gastric motility may
3:02:50lead to reduced appetite. Pregnant
3:02:52individuals often report shifts in taste
3:02:55and smell perception. Furthermore,
3:02:56constipation can be a common issue
3:02:59possibly due to increased progesterone
3:03:01production or pressure from the
3:03:03expanding uterus causing decreased
3:03:05gastrointestinal motility.
3:03:07Physiologically the gastrointestinal
3:03:09system underos alterations sometimes
3:03:11leading to uncomfortable symptoms like
3:03:13flatulence, heartburn and excessive
3:03:15saliva secretion, patilism. These
3:03:18changes are primarily driven by
3:03:20fluctuations in gastrointestinal
3:03:22motility, stomach emptying and rising
3:03:24estrogen levels. Additionally, increased
3:03:27venus pressure may result in the
3:03:29development of hemorrhoids and gum
3:03:31tissue may swell and bleed. The renal
3:03:33system is not immune to these shifts.
3:03:35Frequent urination becomes noticeable in
3:03:37both the first and third trimesters,
3:03:40often accompanied by reduced bladder
3:03:42tone due to heightened progesterone and
3:03:44estrogen levels. Furthermore, the renal
3:03:47threshold for glucose may decrease
3:03:49during pregnancy. Hormonal changes play
3:03:51a pivotal role throughout pregnancy. The
3:03:53basil metabolic rate increases and
3:03:56various endocrine glands adapt to
3:03:58support the developing fetus. Notably,
3:04:00the anterior lobe of the pituitary gland
3:04:03enlarges to produce prolactin for
3:04:05lactation while the posterior lobe
3:04:07generates oxytocin for uterine
3:04:09contractions. The thyroid experiences
3:04:12slight enlargement and heightened
3:04:13activity and parathyroid glands also
3:04:16grow. These hormonal shifts contribute
3:04:18to weight gain and water retention. In
3:04:20the reproductive system, significant
3:04:22transformations occur to accommodate the
3:04:24growing fetus. The uterus underos
3:04:27hyperplasia and hypertrophy while the
3:04:29cervix becomes shorter, more elastic and
3:04:32larger in diameter. Ovaries adjust by
3:04:34inhibiting oum production and
3:04:36secretreting progesterone. Vaginal
3:04:38changes include hypertrophy, muscle
3:04:40thickening, and increased secretions.
3:04:42Breasts enlarge, become tender, and
3:04:45exhibit darker areoli with superficial
3:04:47veins becoming more prominent.
3:04:49Montgomery's follicles may hypertrophy,
3:04:51occasionally leading to colostrum
3:04:53leakage. Pregnancy also has visible
3:04:55effects on the skin. Elevated melanocyt
3:04:58stimulating hormone results in increased
3:05:00pigmentation including the appearance of
3:05:03the lineigra on the abdomen. Collasma
3:05:05often referred to as the mask of
3:05:08pregnancy may develop on the face.
3:05:10Reddish purple stretch marks known as
3:05:12stria gravidarum may emerge on various
3:05:14body parts. Vascular spider nebi might
3:05:17appear and hair growth may accelerate.
3:05:19Muscularkeeletal changes are evident as
3:05:22well. Hormones like relaxin and
3:05:24progesterone affect posture and the
3:05:26lumbro sacral curve potentially leading
3:05:28to aches, numbness, and weakness. Pelvic
3:05:31joints become more mobile and the
3:05:33abdominal wall stretches causing a loss
3:05:35of tone. Beyond the physical, pregnancy
3:05:38triggers psychological shifts. Early on,
3:05:40ambivalence is common, characterized by
3:05:43conflicting feelings of dependence and
3:05:45independence, as well as uncertainty
3:05:47about role changes. Partners may also
3:05:49experience ambivalence regarding their
3:05:51new roles and financial
3:05:52responsibilities. Acceptance of
3:05:54pregnancy varies influenced by
3:05:56readiness. Identification with
3:05:58motherhood, the partner relationship,
3:06:00the bond with the unborn infant, and
3:06:02birth preparation. Emotional ability
3:06:05marked by frequent emotional
3:06:06fluctuations is a common but not
3:06:08necessarily abnormal occurrence during
3:06:10pregnancy. Body image changes driven by
3:06:13physical transformations and
3:06:15accompanying symptoms can influence a
3:06:17woman's self-perception. The
3:06:18relationship with the growing fetus
3:06:20evolves from acknowledging pregnancy to
3:06:22nurturing the developing baby,
3:06:24encompassing preparations for birth and
3:06:26parenthood. Pregnancy often brings
3:06:28discomforts like nausea and vomiting in
3:06:30the first trimester driven by hormonal
3:06:33changes and alterations in carbohydrate
3:06:35metabolism. Managing these discomforts
3:06:37may involve strategies such as consuming
3:06:39dry crackers and avoiding immediate
3:06:41toothbrushing upon waking. Managing
3:06:43nausea and vomiting. First on our list
3:06:45is the challenge of dealing with nausea
3:06:47and vomiting, particularly prevalent
3:06:49during the initial trimester of
3:06:51pregnancy. These symptoms are primarily
3:06:53driven by hormonal fluctuations and an
3:06:55increase in blood volume. To find
3:06:57relief, expecting mothers are encouraged
3:06:59to adopt some practical tactics. Opting
3:07:02for small, frequent, low-fat meals
3:07:04throughout the day, sipping fluids
3:07:06between meals rather than during,
3:07:08avoiding fried and spicy foods,
3:07:10considering acupuncture, consultation
3:07:12with a healthcare provider might be
3:07:14necessary for certain methods,
3:07:16discussing herbal remedies with their
3:07:17healthcare provider, HCP, and when
3:07:20appropriate, taking prescribed
3:07:22anti-imetic medications. Addressing
3:07:24syncopy. Moving on to syncopy, a
3:07:26condition that can surface in the first
3:07:28trimester but may become more frequent
3:07:30in the second and third trimesters.
3:07:32Hormonal shifts, increased blood volume,
3:07:34anemia, fatigue, sudden position
3:07:36changes, or lying flat on your back can
3:07:38trigger syncopy. To prevent fainting
3:07:40episodes, pregnant individuals should
3:07:43take specific precautions. This includes
3:07:45sitting with your feet elevated, being
3:07:47cautious about falls, making slow
3:07:49position changes, and avoiding the
3:07:51supine lying flat on your back position,
3:07:54especially in later trimesters to
3:07:56prevent supine hypotension due to
3:07:58pressure on the inferior venneava.
3:08:00Dealing with urinary urgency and
3:08:02frequency. Urinary urgency and frequency
3:08:04are common discomforts typically
3:08:06experienced in the first and third
3:08:08trimesters due to the pressure exerted
3:08:10on the bladder by the growing uterus.
3:08:12Managing these symptoms involves
3:08:13practical interventions. Expectant
3:08:16mothers are advised to stay hydrated by
3:08:18drinking at least 2,000 milliliters of
3:08:20fluids during the day. Reduce fluid
3:08:22intake in the evening. Empty the bladder
3:08:24regularly. Sleep on their side at night.
3:08:27Use peranal pads as needed and perform
3:08:30kegel exercises to strengthen pelvic
3:08:32floor muscles. Alleviating breast
3:08:34tenderness. Ow. Let's address breast
3:08:36tenderness, which can arise in any
3:08:38trimester due to elevated estrogen and
3:08:41progesterone levels. To alleviate this
3:08:43discomfort, pregnant individuals are
3:08:45encouraged to wear a supportive bra and
3:08:47avoid using soap on the nipples and
3:08:49areola area to prevent skin dryness.
3:08:52Managing increased vaginal discharge.
3:08:54Increased vaginal discharge is a common
3:08:56occurrence throughout pregnancy driven
3:08:58by changes in vaginal mucosa and
3:09:00increased mucus production. Managing
3:09:03this discomfort involves practicing
3:09:05proper cleansing and hygiene techniques.
3:09:07Wearing breathable cotton underwear,
3:09:09avoiding douching, and properly
3:09:11consulting with the healthcare provider,
3:09:13HCP, if an infection is suspected,
3:09:15coping with nasal stuffiness. Nasal
3:09:17stuffiness, which can occur in any
3:09:19trimester due to increased estrogen
3:09:22levels, can lead to nasal tissue
3:09:23swelling and dryness. To alleviate this,
3:09:26individuals are advised to use a
3:09:27humidifier and consult their HCP before
3:09:30using nasal sprays or anti-histamines.
3:09:33Tackling fatigue. Now, let's address
3:09:35fatigue, a common issue in the first and
3:09:38third trimesters, often related to
3:09:40hormonal changes. To combat fatigue, it
3:09:42is recommended to schedule regular rest
3:09:44periods throughout the day. Maintain
3:09:46correct posture and body mechanics.
3:09:48Engage in moderate exercise. Perform
3:09:51relaxation and muscle strengthening
3:09:53exercises. And avoid stimulants found in
3:09:55foods and drinks throughout pregnancy.
3:09:57Relieving heartburn. Heartburn is a
3:09:59discomfort that typically occurs in the
3:10:01second and third trimesters due to
3:10:03increased progesterone levels, decreased
3:10:06gastrointestinal motility, esophageal
3:10:08reflux, and uterine enlargement. To
3:10:11alleviate heartburn, individuals should
3:10:13opt for small, frequent meals, sit
3:10:15upright for 30 minutes after eating,
3:10:17drink milk between meals, avoid fatty
3:10:20and spicy foods, and consult with their
3:10:22HCP about suitable ant acids. Managing
3:10:25ankle edema. Ankle edema or swelling of
3:10:28the ankles is common in the second and
3:10:30third trimesters due to factors like
3:10:32vasidilation, venus stasis, and
3:10:34increased venus pressure below the
3:10:36uterus. To manage this, it is advisable
3:10:38to elevate the legs at least twice
3:10:40daily, sleep on your side, wear
3:10:43supportive stockings or support hose,
3:10:45and avoid extended periods of sitting or
3:10:47standing. Addressing varicose veins.
3:10:50Varicose veins, which typically appear
3:10:52in the second and third trimester, are
3:10:54often caused by weakened vein walls or
3:10:56valves and venus congestion. Effective
3:10:58interventions include wearing supportive
3:11:00stockings or support hose, elevating the
3:11:02feet when sitting, lying with the feet
3:11:04and hips elevated, avoiding prolonged
3:11:06periods of standing or sitting, moving
3:11:08around to improve circulation while
3:11:10standing, refraining from leg crossing,
3:11:12avoiding constricting clothing like knee
3:11:14high stockings, learning leg exercises,
3:11:17and minimizing prolonged airline travel.
3:11:19Managing headaches. Headaches are
3:11:21generally considered benign in the first
3:11:23trimester, but may require further
3:11:25investigation if they occur in the
3:11:27second and third trimesters. They can
3:11:29result from changes in blood volume and
3:11:31vascular tone. To manage headaches,
3:11:33individuals should change positions
3:11:34slowly. Apply a cool cloth to the
3:11:37forehead, have a small snack, and use a
3:11:39set of menopen only if prescribed by the
3:11:41HCP. Alleviating hemorrhoids.
3:11:43Hemorrhoids are common in the second and
3:11:46third trimesters due to increased venus
3:11:48pressure and constipation. To alleviate
3:11:50discomfort, it is recommended to soak in
3:11:52a warm sits bath, sit on a soft pillow,
3:11:55consume high-fiber foods, increase
3:11:57exercise such as walking, and use
3:11:59ointments, suppositories, or compresses
3:12:02as prescribed by the HCP. Addressing
3:12:05constipation. Constipation often occurs
3:12:07in the second and third trimesters due
3:12:09to hormonal changes, decreased
3:12:11intestinal motility, and pressure from
3:12:13the growing uterus. To address this
3:12:15issue, individuals should consume
3:12:17high-fiber foods like whole grains,
3:12:19fruits, and vegetables, drink at least
3:12:222,000 ml of fluids daily, engage in
3:12:25regular exercise, such as a 20minut
3:12:27walk, and consult with your HCP for
3:12:30stool softeners, laxatives, or enemas if
3:12:32needed. Managing backachche. Backache is
3:12:35common in the second and third
3:12:37trimesters due to an enlarged uterus
3:12:39causing an exaggerated lumbossacral
3:12:41curve. To alleviate back pain and reduce
3:12:43the risk of falls, it is recommended to
3:12:45take regular rest breaks. Maintain
3:12:48correct posture and body mechanics. In
3:12:50our comprehensive exploration of
3:12:52maternal risk factors, let's delve into
3:12:54the multiaceted aspects that can exert
3:12:57an influence on paranatal outcomes. One
3:12:59pivotal determinant is maternal age, and
3:13:02it wields a substantial impact on these
3:13:04outcomes. Elevated risks are associated
3:13:07with both youthful mothers under the age
3:13:09of 20 and more mature mothers over 35
3:13:12years of age. When considering
3:13:14adolescent pregnancy, a myriad of
3:13:16factors converge to contribute to its
3:13:18occurrence. These encompass early
3:13:20monarchy, shifts in sexual behaviors,
3:13:22familiar discord, economic hardships,
3:13:25and limited reproductive and
3:13:27contraceptive knowledge. Regrettably,
3:13:29adolescent pregnancies bring forth a
3:13:31spectrum of formidable challenges
3:13:33including insufficient nutritional
3:13:35intake, emotional and behavioral
3:13:37complexities, posity of support systems,
3:13:40escalated risks of still birth, low
3:13:43birthw weightight infants, fetal
3:13:44mortality, sephilopelvic disproportion,
3:13:47and augmented maternal complications
3:13:50such as hypertension, anemia, prolonged
3:13:52labor, and infections. As healthc care
3:13:55providers, our pivotal role in
3:13:56mitigating the risks and consequences of
3:13:59adolescent pregnancy cannot be
3:14:00overstated. We must ardently advocate
3:14:03for prompt and continuous prenatal care
3:14:06while judiciously referring adolescence
3:14:08to the requisite support systems when
3:14:10circumstances necessitate it,
3:14:12particularly in ameliorating the adverse
3:14:14effects of unfavorable socioeconomic
3:14:17conditions. Nutrition emerges as a
3:14:19foundational pillar of a healthy
3:14:21pregnancy. Adequate nutritional
3:14:22sustenance is indispensable for the
3:14:24unimpeded growth and development of the
3:14:26fetus. With distinct dietary
3:14:28requirements evolving throughout various
3:14:30stages of pregnancy, it is incumbent
3:14:32upon us to recommend folic acid
3:14:34supplements to women of childbearing age
3:14:36to preempt neural tube defects and oral
3:14:39facial clefts in the developing fetus.
3:14:42Genetic considerations loom large in
3:14:44this context. Genetic assessments
3:14:46facilitate the identification of
3:14:48inheritable risk factors for congenital
3:14:50anomalies. Timely prenatal care, which
3:14:53encompasses dental health, assumes
3:14:55paramount importance in curtailing the
3:14:57risk of pre-term birth and low birth
3:15:00weight. Regrettably, some adolescents
3:15:02may find themselves ins snared in
3:15:04situations of abuse and violence which
3:15:06can invariably escalate the risk of
3:15:08complications such as abruptio placente,
3:15:11preterm birth and infections stemming
3:15:13from unwanted or coerced sexual
3:15:15encounters. Thus, it is incumbent upon
3:15:17us to approach these issues with the
3:15:19utmost sensitivity and offer appropriate
3:15:22support and interventions. Medical
3:15:23conditions such as diabetes malitis,
3:15:26hypertensive disorders or cardiac
3:15:28ailments can amplify the risks
3:15:30associated with pregnancy underscoring
3:15:32the imperative for vigilant monitoring
3:15:34and adept management. Turning our
3:15:36attention to other risk factors,
3:15:38maternal infection with German measles
3:15:41rebella within the first 8 weeks of
3:15:43gastation pose the highest risk of fetal
3:15:46infection. Sexually transmitted
3:15:47infections carry significant
3:15:49implications during pregnancy as well.
3:15:51Syphilis for example can traverse the
3:15:53placental barrier culminating in
3:15:55spontaneous abortions and an escalated
3:15:57risk of mental impairment and physical
3:15:59deformities. Condaloma cuminatum human
3:16:01papilloma virus can be transmitted
3:16:03during vaginal child birth fostering the
3:16:06development of epithelial tumors in the
3:16:08mucous membranes of the lics in infants.
3:16:11Gonorrhea has the potential to infect
3:16:12the neonate at birth giving rise to
3:16:14complications such as athalmia neonatum
3:16:17pneumonia and sepsis. Clamial infection
3:16:20when transmitted during vaginal delivery
3:16:22can precipitate neonatal conjunctivitis.
3:16:25Pneumonitis, premature rupture of
3:16:27membranes, premature labor and
3:16:29postpartum endometritis. Tchominus has
3:16:32been associated with premature rupture
3:16:34of membranes and postpartum
3:16:35endometritis. Genital herpes simplex
3:16:38virus characterized by painful lesions
3:16:40can entail grave consequences
3:16:42accentuating the need for judicial
3:16:44assessment and management during
3:16:46pregnancy. Transmission of the human
3:16:48immuno deficiency virus HIV can
3:16:51transpire through various routes
3:16:53including exposure during childirth and
3:16:55breastfeeding. Preventive measures may
3:16:57encompass the paranatal administration
3:16:59of Zenovadine. Substance abuse during
3:17:01pregnancy poses a substantial risk to
3:17:03fetal growth and development potentially
3:17:05leading to fetal growth restriction,
3:17:07abrupt placente and fetal brackia. It is
3:17:11imperative to issue territogenic
3:17:13substances and over-the-counter
3:17:14medications without the approval of a
3:17:16health care provider. Finally, viral
3:17:18hepatitis with further details available
3:17:21in chapter 26 and chapter 52 for
3:17:23hepatitis B is an additional cause for
3:17:26concern. Now, let us pivot our focus to
3:17:28antipartum diagnostic testing.
3:17:30Throughout pregnancy, healthcare visits
3:17:32typically adhere to a schedule of every
3:17:344 weeks up to 28 to 32 weeks, every 2
3:17:38weeks from 32 to 36 weeks, and weekly
3:17:41from 36 to 40 weeks. Crucially, blood
3:17:44type and Rh factor testing are
3:17:46indispensable in discerning blood
3:17:48compatibility and ascertaining the
3:17:50necessity for ROD, immunoglobilin,
3:17:53rogam, in Rh negative clients. Reubella
3:17:56tighter testing assumes pivotal
3:17:58importance. Clients exhibiting negative
3:18:00rebella titers should receive the
3:18:02requisite immunization postpartum with a
3:18:05concerted emphasis on birth control and
3:18:08avoiding contact with imunompromised
3:18:10individuals. The monitoring of
3:18:12hemoglobin and hemodocrit levels stands
3:18:14as an imperative during pregnancy as any
3:18:17decline may signal the onset of anemia.
3:18:19Furthermore, a peponylouse smear is
3:18:22conducted during the initial prenatal
3:18:23examination to screen for cervical
3:18:25neoplasia. Collectively, these factors
3:18:28and tests occupy an indispensable role
3:18:30in safeguarding the health and
3:18:32well-being of both the expectant mother
3:18:34and the burgeoning fetus during the
3:18:36intricate journey of pregnancy. Now, we
3:18:38will explore a range of prenatal
3:18:40screening tests and procedures aimed at
3:18:42safeguarding the health and well-being
3:18:44of both the expectant mother and the
3:18:46developing fetus. Screening for sexually
3:18:48transmitted infections, STI. This
3:18:51assessment is indispensable for gauging
3:18:53the client's risk and determining the
3:18:55need for further evaluation and
3:18:56treatment based on the outcomes. Cickle
3:18:58cell disease screening. Moving on to
3:19:00cickle cell disease screening. This is
3:19:02typically recommended for clients at
3:19:03risk. A positive test result might
3:19:06trigger the requirement for additional
3:19:07screening and follow-up ensuring timely
3:19:09intervention and appropriate care.
3:19:11Tuberculin skin test. Following child
3:19:13birth, healthcare providers may opt for
3:19:15the tuberculin skin test. A positive
3:19:18result on this skin test suggests the
3:19:20necessity of a chest radioraph. However,
3:19:23it's important to note that pregnant
3:19:25clients should only undergo radiography
3:19:27after reaching 20 weeks of gastation
3:19:29when fetal organs are fully developed.
3:19:32Those who convert to a positive result
3:19:34may be referred for postpartum
3:19:35medicationbased treatment. Hepatitis B
3:19:38surface antigen testing. Hepatitis B
3:19:40antigen testing is advisable for all
3:19:42pregnant women due to the prevalence of
3:19:44the disease in the general population.
3:19:46In specific cases such as healthare
3:19:48workers, introvenous drug users, and
3:19:50individuals with particular risk
3:19:52factors, hepatitis B vaccination may be
3:19:55recommended. It's noteworthy that
3:19:57hepatitis B vaccination is not
3:19:59contraindicted during pregnancy and may
3:20:01be suggested by the healthcare provider
3:20:03for at risk individuals. Ur analysis and
3:20:06urine culture. Next, we come to
3:20:08urinalysis and urine culture, which
3:20:10constitute an essential component of
3:20:12antipartum visits. During each visit, a
3:20:14urine specimen is collected for glucose
3:20:16and protein assessments. Glycosurora,
3:20:19which is often observed during
3:20:21pregnancy, may arise due to a lowered
3:20:23renal threshold. However, persistent
3:20:26glycosura may be indicative of diabetes.
3:20:28Additionally, the presence of white
3:20:30blood cells in urine points to infection
3:20:32while keenora can result from inadequate
3:20:35food intake or vomiting. Importantly,
3:20:37protein levels of 2 plus to 4 plus in
3:20:40urine may suggest infection or
3:20:42preeacclampsia necessitating further
3:20:44evaluation and management. Ultraography.
3:20:47Ultraography assumes a critical role in
3:20:49visualizing and identifying fetal and
3:20:52maternal structures. It assists in
3:20:54confirming gestational age, estimating
3:20:56the due date, and evaluating amniotic
3:20:59fluid volume through specialized
3:21:01measurements. Ultra synography can be
3:21:03conducted abdominally or transvaginally
3:21:05during pregnancy. For abdominal
3:21:08ultrasounds, clients may be advised to
3:21:10consume water to fill the bladder,
3:21:12enhancing visualization. Transvaginal
3:21:14ultrasound entails the insertion of a
3:21:16lubricated probe into the vagina.
3:21:18Importantly, this procedure is not
3:21:20associated with any known risks to
3:21:22either the client or the fetus.
3:21:24Biofysical profile. The biohysical
3:21:27profile is a non-invasive evaluation of
3:21:30fetal well-being encompassing
3:21:31assessments of fetal breathing movements
3:21:34movements tone amniotic fluid index and
3:21:37fetal heart rate patterns through a
3:21:39nonstress test. Normal fetal biohysical
3:21:41activities indicate proper central
3:21:43nervous system function and adequate
3:21:45oxygenation providing valuable insights
3:21:48into fetal well-being. Doppler blood
3:21:50flow analysis. Doppler blood flow
3:21:52analysis is a non-invasive ultrasound
3:21:54technique used to study blood flow in
3:21:56the fetus and placenta facilitating the
3:21:59assessment of fetal circulation and
3:22:00health. Perccutaneous umbilical blood
3:22:03sampling pubs. Pubs is carried out when
3:22:05fetal blood sampling becomes necessary.
3:22:08This procedure involves the insertion of
3:22:10a needle into the fetal umbilical vessel
3:22:12under ultrasound guidance. Fetal heart
3:22:14rate monitoring is required for 1 hour
3:22:16post procedure with a subsequent
3:22:18ultrasound to check for bleeding or
3:22:20hematoma formation. Rh negative women
3:22:23may receive rod d immunoglobulin due to
3:22:25the increased risk of Rh sensitization.
3:22:28Alpha feta protein screening. Alpha
3:22:30protein screening involves the
3:22:32assessment of fetal serum protein
3:22:33levels. Abnormal levels can indicate
3:22:36open neural tube and abdominal wall
3:22:38defects as well as help screen for
3:22:40spinobipida and down syndrome. In the
3:22:42event of abnormal levels, repeat testing
3:22:44is advised as false positives can occur.
3:22:48This screening entails a maternal blood
3:22:49sample taken between 16 and 18 weeks of
3:22:52gastation followed by further evaluation
3:22:55ultrasound examination for elevated
3:22:57levels. Deoxxyribboucleic
3:22:59acid DNA genetic testing. DNA genetic
3:23:02testing is employed to identify
3:23:03abnormalities related to inherited
3:23:06conditions and to determine the risk of
3:23:07having a fetus with specific genetic
3:23:10disorders. This testing can be conducted
3:23:11as early as 7 weeks of gastation using a
3:23:14blood sample offering valuable
3:23:16information to inform decision-making.
3:23:18Corionic villa sampling. CVS. CVS is
3:23:21performed to detect genetic
3:23:23abnormalities by aspirating a small
3:23:25sample of corionic villis tissue between
3:23:2810 and 13 weeks of gastation. This
3:23:30procedure necessitates informed consent
3:23:32and may involve bladder filling for
3:23:34visualization if performed before 20
3:23:37weeks. It also entails monitoring vital
3:23:39signs and fetal heart rate. Rh negative
3:23:42women may receive RO D immune globalin
3:23:44due to the increased risk of Rh
3:23:47sensitization. Amnocentthesis.
3:23:49Amnocentthesis entails the aspiration of
3:23:51amniotic fluid and is ideally conducted
3:23:54between 15 and 20 weeks of pregnancy.
3:23:56This procedure aids in the detection of
3:23:58genetic disorders, metabolic defects,
3:24:00and the assessment of fetal lung
3:24:02maturity. While amnneocentesis is a
3:24:04valuable diagnostic tool, it carries
3:24:07potential risks such as maternal
3:24:09hemorrhage infection, Rh isommunization,
3:24:12abrupt placente, amniotic fluid emblei,
3:24:15and premature rupture of the membranes.
3:24:17Prior to amnneocentesis, clients provide
3:24:20informed consent. Bladder status is
3:24:22considered, ultraography aids in
3:24:25locating the placenta and continuous
3:24:27monitoring of vital signs and fetal
3:24:29heart rate is implemented. Kick counts.
3:24:31Fetal movement counting. Lastly, we have
3:24:33kick counts. A simple yet crucial
3:24:36practice. Clients are instructed to sit
3:24:38quietly or lie down on their side to
3:24:40count fetal kicks. Clients should
3:24:42promptly inform the healthcare provider
3:24:44if there are fewer than 10 kicks in two
3:24:46consecutive 2-hour periods or as
3:24:49instructed by the provider as this could
3:24:51indicate potential issues warranting
3:24:53further evaluation and monitoring. The
3:24:55Fern test. It serves as a microscopic
3:24:58slide examination to detect amniotic
3:25:00fluid leakage. This entails collecting a
3:25:03specimen from the cervix and vaginal
3:25:05pool. Subsequently examining it under a
3:25:07microscope to identify a fern like
3:25:10pattern indicative of amniotic fluid
3:25:12presence. During this procedure, it is
3:25:14crucial to position the client in the
3:25:16dorsal lothomtomy position and instruct
3:25:18her to cough as this may induce amniotic
3:25:21fluid leakage if the membranes are
3:25:22ruptured. Now let's delve into the
3:25:24nitriine test. utilized to identify
3:25:27amniotic fluid in vaginal secretions.
3:25:29Vaginal secretions typically have a pH
3:25:32ranging from 4.5 to 5.5, which does not
3:25:35affect the test strip or swab. However,
3:25:38amniotic fluid with a pH ranging from
3:25:417.0 to 7.5 will cause the test strip or
3:25:45swab to turn blue. To conduct this test,
3:25:48position the client in the dorsal
3:25:49lethtomy position. Apply the test tape
3:25:52to the fluid and observe it for a blue
3:25:54to green, blue to gray, or deep blue
3:25:57color change indicating the presence of
3:25:59ruptured membranes and amniotic fluid
3:26:01leakage. Lastly, let's discuss the
3:26:04fibonctin test which involves collecting
3:26:06cervical and vaginal secretions to
3:26:08detect fetal fibonctin, a protein found
3:26:11during specific gastational periods.
3:26:14Positive results may suggest the onset
3:26:16of labor in 1 to 3 weeks, while negative
3:26:18results are more predictive of the
3:26:20absence of preterm labor. This test is
3:26:22typically employed when there is a risk
3:26:24of preterm labor. To perform the
3:26:26fibonctin test, place the client in a
3:26:28lothottomy position for a sterile
3:26:30speculum examination. Obtain cervical
3:26:33secretions using a cotton swab and send
3:26:35the samples to the laboratory for
3:26:36fibroctin presence analysis. Now, let's
3:26:39move on to some guidelines regarding
3:26:41nutrition during pregnancy. Expectant
3:26:43mothers should aim for an expected
3:26:45weight gain of 25 to 35 lbs for those
3:26:49with a normal pregnancy weight. An
3:26:50additional 300 calories per day are
3:26:53needed during pregnancy with calorie
3:26:55needs increasing in the later trimesters
3:26:57compared to the first. During lactation,
3:26:59an extra 500 calories per day are
3:27:01required. Folic acid supplements are
3:27:03essential for all women of childbearing
3:27:05age to prevent neural tube defects and
3:27:08oral facial clefts in the fetus.
3:27:09Adequate hydration is also vital with
3:27:12the goal of consuming at least 8 to 10 8
3:27:14oz glasses of fluid daily, including
3:27:17four to six glasses of water. Sodium
3:27:19intake is not restricted unless
3:27:21prescribed by the healthcare provider.
3:27:23For individuals following vegan and
3:27:25vegetarian diets, it is crucial to
3:27:27ensure a varied diet to meet normal
3:27:29nutrient and energy requirements.
3:27:31Clients should be educated about
3:27:33consuming complimentary proteins
3:27:35throughout the day to provide all
3:27:37essential amino acids. Potential
3:27:39deficiencies in these diets include
3:27:41energy, protein, vitamin B12, zinc,
3:27:45iron, calcium, omega-3 fatty acids, and
3:27:48vitamin D if limited sunlight exposure.
3:27:51Increasing protein consumption with a
3:27:53variety of vegetable protein sources,
3:27:55enhancing iron absorption by pairing it
3:27:57with vitamin D rich foods, and including
3:27:59a variety of plant-based foods are
3:28:02recommended. Lactose intolerance can
3:28:04lead to digestive discomfort and clients
3:28:06with this condition should incorporate
3:28:08non-dairy calcium sources into their
3:28:10diets. Cooked forms of milk such as
3:28:12custards or fermented dairy products may
3:28:14be tolerated along with cheese and
3:28:16yogurt. Lactase supplements can be
3:28:19prescribed and lactase treated milk or
3:28:21lactosefree products are commercially
3:28:23available. Lastly, we discussed pika, a
3:28:26condition involving the consumption of
3:28:28non-food substances. This cause is
3:28:31unclear but cultural beliefs may play a
3:28:33role. PA can result in iron deficiency
3:28:36anemia. So addressing this behavior is
3:28:38important. Now let's delve into the
3:28:40nonstress test NST and contraction
3:28:43stress test CST. The nonstress test
3:28:46evaluates the function and oxygenation
3:28:48of the placenta and assesses fetal
3:28:50well-being by examining the fetal heart
3:28:52rate FHR response to fetal movement. To
3:28:55perform this test, an external
3:28:57ultrasound transducer and tacoer are
3:29:00applied to the client to record a
3:29:02tracing lasting at least 20 minutes.
3:29:04This allows observation of both the FHR
3:29:07and uterine activity. Baseline blood
3:29:09pressure is measured and blood pressure
3:29:11is monitored frequently. The client is
3:29:13positioned in the lateral side lying
3:29:16position to prevent vennea compression.
3:29:18Additionally, the client may be
3:29:19instructed to press a button whenever
3:29:21she feels fetal movement, and the
3:29:22monitor records these movements as
3:29:24reference points for assessing the FH
3:29:27response. Results for the nonstress test
3:29:29can be categorized as reactive,
3:29:32indicating a healthy fetus,
3:29:34non-reactive, abnormal, or
3:29:36unsatisfactory when the tracing quality
3:29:38is insufficient for interpretation.
3:29:41Moving on to the contraction stress
3:29:42test. It is performed to assess
3:29:44placental oxygenation and function,
3:29:47evaluate the fetus's ability to tolerate
3:29:49labor, and assess fetal well-being.
3:29:51During this test, the fetus is exposed
3:29:54to contractions to evaluate placental
3:29:56profusion under simulated labor
3:29:58conditions. It is typically performed
3:30:00when the nonstress test yields abnormal
3:30:02results. To perform the contraction
3:30:04stress test, an external fenal monitor
3:30:06is applied to the client and a baseline
3:30:09strip of 20 to 30 minutes is recorded.
3:30:11Uterine contractions are induced, either
3:30:13through oxytocin administration or
3:30:15nipple stimulation until three palpable
3:30:18contractions with a duration of 40
3:30:20seconds or more in a 10-minute period
3:30:22are achieved. Frequent maternal blood
3:30:25pressure readings are taken and
3:30:26monitoring occurs while oxytocin doses
3:30:29are increased. Before we move ahead, let
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3:31:58video. Let's delve into laboratory
3:32:01values. A key topic on your X exam. This
3:32:05segment is crucial for your success as
3:32:07you'll encounter about three questions
3:32:09related to it on the exam. Understanding
3:32:11lab values is vital for patient care and
3:32:15is a must know for any aspiring nurse.
3:32:18Get ready to explore this fascinating
3:32:20and essential subject. Serum sodium
3:32:24crucial role as a major cation in the
3:32:26extracellular fluid where it helps
3:32:28maintain osmotic pressure and acidbased
3:32:31balance and assists in transmitting
3:32:33nerve impulses. It is absorbed small
3:32:36intestine and its excretion through
3:32:38urine varies based on dietary intake.
3:32:40The normal reference range for ceram is
3:32:43between 135 to 145 mil equivalents per
3:32:47liter. It's important to note that
3:32:50drawing blood from an extreme IV
3:32:51solution is infusing can yield
3:32:53inaccurate results depending on the test
3:32:56and type of solution. Additionally,
3:32:58prolonged use of a tourniquet before
3:33:01venous sampling can elevate potassium
3:33:03levels in the blood. Serum potassium a
3:33:07major intracellular cation critical for
3:33:10regulating cellular water balance
3:33:12electrical conduct in muscle cells and
3:33:14acid base balance. The body acquires
3:33:17potassium through diet and the kidneys
3:33:20either conserve or excrete it according
3:33:22to cellular need. Potassium levels are
3:33:24vital for assessing cardiac, renal,
3:33:27gastrointestinal functions and
3:33:29determining the necessity for IV
3:33:31therapy. Notably, if a client is
3:33:34receiving potassium supplements, this
3:33:36should be indicated on the laboratory
3:33:38form. Elevated cell and platelet counts
3:33:41can falsely increase potassium levels.
3:33:44The normal range for septac is between
3:33:463.5 to 5.0 ms per liter. Activated
3:33:51partial thromboplasm APTT is used to
3:33:55evaluate the intrinsic clotting system
3:33:57by measuring the time it takes
3:33:59recalcified citrated plasma to clot
3:34:02after adding partial thromboplastin.
3:34:05This test is useful for monitoring hepin
3:34:07therapy and screening for quarters
3:34:09excluding factors 7 and 13. The normal
3:34:12reference interval for an apt is 28 to
3:34:1635 seconds. Although this can vary based
3:34:19on the activate used blood samples
3:34:21should be drawn 1 hour before the next
3:34:24heperin dose during intermittent therapy
3:34:26and should not be drawn from an armin
3:34:29infusion. Immediate transport of the
3:34:31specimen to the lab is crucial. The AT
3:34:35should be 1.5 to 2 point normal value
3:34:38during heperin therapy. If the APTT
3:34:41value is prolonged in a client receiving
3:34:43IV heperin therapy or at risk for
3:34:46thrombocenia bleeding precautions should
3:34:48be initiated. Prothroen time PT and
3:34:52international normalized ratio INR
3:34:55involve measuring the time for formation
3:34:57to monitor the response to warerin
3:34:59sodium or to screen for exttrinsic
3:35:02clotting system dysfunctions due to
3:35:03liver disease, vitamin K deficiency or
3:35:06disseminated coagulation. Each
3:35:09laboratory establishes its own control
3:35:11value for PT and a PT value within 2
3:35:14seconds or minus of the control is
3:35:16considered normal. In obtaining blood
3:35:19samples, whether through vent puncture
3:35:21or intravenous lines, it's important to
3:35:23elect an appropriate vein. Ensure
3:35:26cleanliness and proper technique
3:35:28specimens correctly per agency policy.
3:35:30This includes using antiseptic swabs,
3:35:33choosing the right angle for needle
3:35:35insertion, ensuring needle safety post
3:35:37collection and applying appropriate
3:35:39pressure at the insertion site. Hand
3:35:42hygiene and transportation of the
3:35:43specimen to the laboratory are also
3:35:46vital steps in the process. The
3:35:49international ratio INR is an essential
3:35:52test for measuring effectiveness of
3:35:54certain anti-coagulants.
3:35:56It says the proth thrombin time PT ratio
3:35:59by raising the observed PT ratio to the
3:36:02power of the international sense index
3:36:04which varies depending on the
3:36:05thromboplastin reagent used in the
3:36:07laboratory before starting
3:36:10anti-coagulation therapy. It's important
3:36:12to obtain a baseline specimen ensuring
3:36:15to note of collection on the lab form.
3:36:18Applying direct pressure for 3 to 5
3:36:20minutes at the venipuncture site is
3:36:22crucial to prevent bleeding. Warren
3:36:25therapy when given concurrently with
3:36:27heperin den the PT for up to 5 hours
3:36:30post dosing. Diets rich in green leaf
3:36:33vegetables which are high in K shorten
3:36:35the PT by enhancing vitamin K
3:36:37absorption. Oral anti-coagulants
3:36:40typically maintain the PT at 1 to 5 to
3:36:42two times the normal laborator value.
3:36:45For proth thrombin time, normal ranges
3:36:48are 11 to 12 seconds. And for IR, it's 2
3:36:51to three for standard warfin therapy and
3:36:543 to 4.5 for high dose therapy. If the
3:36:58PT exceeds 32 seconds and the INR is
3:37:01above 3.0 in patient receiving standard
3:37:04warfin therapy, precautions should be
3:37:06initiated as per agency policy. Platelet
3:37:09count is another crucial test. Platelets
3:37:11playing a key role in hemostasis, clot,
3:37:15and coagulation factor activation
3:37:17produced by the bone marrow. Their
3:37:19normal is 150,000 to 400,000 m to the
3:37:24third power. It's important to monitor
3:37:26your sight for bleeding in patients with
3:37:28thrombocytoenia. Factors like high
3:37:30altitudes, cold weather, and exercise
3:37:33can increase platelet counts. Bleeding
3:37:35precautions are necessary when platelet
3:37:37counts fall significantly below normal
3:37:40and close monitoring is needed in
3:37:41patients undergoing chemotherapy to the
3:37:44risk of thrombocytoenia.
3:37:46Prior to any invasive procedure,
3:37:48coagulation studies and the platelet
3:37:50counts should be assessed. Hemoglobin
3:37:53and hemotr tests are also key.
3:37:56Hemoglobin the main component of red
3:37:58blood cells transgen and carbon dioxide
3:38:02while hematocrit measures the mass of
3:38:04red blood cells crucial in diagnosing
3:38:06anemia or polyythemeia.
3:38:08Fasting is not required for these tests.
3:38:12Lip panels incl HDL, LDL and
3:38:15triglycerides.
3:38:17Cholesterol is a major component of LDLs
3:38:20and is found in brain and nerve cells,
3:38:22cell membranes and some gallstones.
3:38:25Triglycerides synthesized in the liver
3:38:27and up and from diet are a significant
3:38:30part of very low density lipoproteins.
3:38:33Cholesterol LDL and triglyceride levels
3:38:36increase the risk of coronary artery
3:38:38disease while HDL offers some
3:38:40protection. Oral contraceptives may
3:38:43elevate lipid levels. Before testing, a
3:38:4612 to 14-hour fasting period, excluding
3:38:49alcohol for 24 hours and avoiding high
3:38:51cholesterol foods the evening before are
3:38:54advised.
3:38:56Testing blood glucose levels vital for
3:38:58diagnosing diabetes and hypoglycemia
3:39:01require an 8 to 12hour. Diabetic
3:39:04patients should withhold morning insulin
3:39:06or hypoglycemication until after the
3:39:09test. Normal fasting glucose ranges from
3:39:12710 mg per dl. The HBA1C test reflects
3:39:17blood glucose control the past 3 to 4
3:39:20months. Elevated levels usually indicate
3:39:22hypoglycemia in diabetic patients. This
3:39:25test does not require fasting and normal
3:39:28ranges are between 4.0% to 6.0%.
3:39:32Renal function studies include serumine
3:39:35and blood ura nitrogen tests. Creatin
3:39:38gate renal function with increased
3:39:40levels suggesting a reduced glomeular
3:39:43filation rate. Avoid excessive exercise
3:39:45and red me intake before the test.
3:39:48Normal cranium levels range from 0.6 to
3:39:511.3 M per DL. Bun reflects protein
3:39:54breakdown in the liver with normal
3:39:56levels ranging from 6 to 20 mg per dl.
3:40:00Finally, white blood cell WBC counts are
3:40:03critical for understanding the body's
3:40:05immune defense. C differential provides
3:40:08detailed information on various types of
3:40:10WBC differential can indicate different
3:40:12health conditions such as bacterial
3:40:15infections. Arrow recovery normal WBC
3:40:18counts range from 5,000 to 10,000 mm to
3:40:22the third power. Exciting alert. Before
3:40:26we jump in to our next topic, we've got
3:40:28a thrilling opportunity for you. Win
3:40:30big. Yes, you are right. A $1,000 is up
3:40:34for grabs. We're sprinkling random
3:40:37questions every hour of this course,
3:40:39giving you multiple chances. Here comes
3:40:42your next of contest questions. What is
3:40:45the most common type of renal stone in
3:40:47the human body?
3:40:50Next question is, Murphy's son is
3:40:52associated with which dise? Type your
3:40:55responses in the comment box right away.
3:40:58Not just a test of your knowledge, but a
3:41:00chance to pop some serious cash. Ready,
3:41:03set, learn. Remember, each correct
3:41:05answer brings you closer to that sweep
3:41:08prize. Good luck. Now, back to the
3:41:11topic. Lab tests play a crucial role in
3:41:14meta diagnostics and among the various
3:41:17types of tests commonly performed. Some
3:41:19of the most significant include
3:41:21metabolic tests. These tests are
3:41:24essential for determining a patients
3:41:25fluid and electrolyte balance along with
3:41:28other metabolic parameters like blood
3:41:30glucose levels, protein levels, liver
3:41:33enzyme. There are two primary cateers of
3:41:35metabolic tests. The metabolic panel BMP
3:41:39and the metabolic panel CMP. The BMP
3:41:43typically includes eight different tests
3:41:45such as glucose, calcium, sodium,
3:41:49chloride, potium, CO2, blood uritrogen,
3:41:53bun and creatinine, and is often part of
3:41:57routine physical examinations. The CMP
3:42:00on the other hand includes all the tests
3:42:02from the BMP plus additional liver
3:42:04function tests making a total of 15
3:42:07tests which also cover parameters ALP
3:42:11ALT
3:42:13bilerubin total protein albumin and
3:42:17globulin complete blood counts CBC this
3:42:21test is crucial for determining the
3:42:23number and types of set in a patient's
3:42:25blood sample it includes several
3:42:27parameters but the most Common rested
3:42:29ones include hemoglobin which is the
3:42:31protein component of red blood cells
3:42:34putting oxygen throughout the body and
3:42:36homocrid which measures the proportion
3:42:38of red blood cells in the blood and
3:42:40serves as an indicator of an
3:42:42individual's status. The test also
3:42:44measures white blood cells WBC's which
3:42:47are critical for ability to fight off
3:42:49infections. Additionally, the CBC
3:42:52provides detailed information about red
3:42:54blood cell indices like mean corpuscular
3:42:56volume MCV, hemoglobin, CH and red cell
3:43:01distribution with RDW which are helpful
3:43:04in diagnosing various conditions
3:43:07including types of anemia. The CBC also
3:43:10measures platelet count which is vital
3:43:12for understanding clotting disorders.
3:43:14Coagulation studies. These tests are
3:43:17designed to assess bleeding disorders
3:43:19and are more detailed account in a CBC.
3:43:22They are particularly important for
3:43:24patients with heat conditions or those
3:43:26taking anti-coagulants
3:43:28and coagulation studies include
3:43:30pro-throen time PTT international ratio
3:43:34INR and activated partial thromboplastin
3:43:37time. Urine analysis typically performed
3:43:41as part of gene tests for patients
3:43:43admitted to hospitals. Urine analysis
3:43:46helps in determining the presence of
3:43:48urinary tract infection, potential
3:43:49kidney damage, and a patients hydration
3:43:51status. It is also useful in monitoring
3:43:54the response of patients with urinary
3:43:56tract infections to treatment. Arterial
3:43:59blood gases, ABGs.
3:44:02These tests are important for assessing
3:44:04not only the fluid and electrolyte
3:44:06balance, but also respiratory and
3:44:09metabolic conditions of patients.
3:44:11critical information about the patients
3:44:13blood levels and pH balance. Lipid
3:44:16profile. This of tests determines the
3:44:19level of cholesterol, triglycerides, and
3:44:21other lipoproteins in the blood. It's
3:44:24instrumental a patient's risk for
3:44:26coronary arteries in guiding the
3:44:28management of these conditions. The
3:44:30hemoglobin test is critical tool for
3:44:33diagnosing diabetes. It measures a
3:44:35patient's average blood glucose levels
3:44:37over a period of 3 to four months
3:44:39coincides with the lifespan of a red
3:44:41blood cell. This test is particularly
3:44:44useful for monitoring a patient's
3:44:45adherent plan and evaluating their
3:44:48response to the obtaining samples from
3:44:50the patient. Firstly, the cornerstone
3:44:53any medical procedure including sample
3:44:56collection is informed consent. It's
3:44:58vital to start by discussing with the
3:45:00patient why the sample is needed and how
3:45:02it will be collected. It isn't just a
3:45:04formality. It's about building trust and
3:45:07in the patient is comfortable and
3:45:09informed.
3:45:10Next, we must coordinate collaboratory.
3:45:13This is a crucial step ensures the
3:45:15sample we collect remains viable for
3:45:17testing. Imagine a relay race where the
3:45:20baton is the patient's sample and to
3:45:22passes smoothly to the lab team for
3:45:24Nessus. Now, let's talk about preparing
3:45:27our patient. If the test works fasting
3:45:30like a blood glucose test, we need to
3:45:32inent well in advance. This preparation
3:45:36is essential for accurate result then we
3:45:38explain the procedure in detail ensuring
3:45:40the patient knows exactly what to
3:45:42expect. Lastly the site from where the
3:45:45sample will be collected. This might
3:45:47involve cleaning the area with septic
3:45:49which is crucial to prevent infection.
3:45:52On to the actual collection procedures.
3:45:54Let's look at three types. vein sample,
3:45:58central line sample, taterial blood gas.
3:46:01Each type has its depths. For instance,
3:46:04a peripheral vein sample, we ask the
3:46:06patient to make a fist, locate the vein,
3:46:09and insert the needle. It's a bit like
3:46:11finding the right spot to pierce an
3:46:13orange peel without going too deep.
3:46:15After drawing the blood, we swiftly
3:46:17remove the needle and apply pressure to
3:46:18the site discomfort and preventing
3:46:21bleeding. For essential lines, a bit
3:46:24different. We clean the port with
3:46:26alcohol. Let it air dry. Carefully draw
3:46:29the sample. This is similar to tapping a
3:46:32keg but requires a gentle and precision.
3:46:34The arterial blood gas collection is
3:46:37quite unique. We explain that we're
3:46:39using an artery vein which might make
3:46:41blood appear brighter. This collection
3:46:44requires a del to ensure patient comfort
3:46:47and accurate sampling. When it comes to
3:46:49urine specimens, the midstream catch
3:46:52method is most common. We guide the
3:46:54patient cleaning their perennial area
3:46:56and the technique affecting the sample.
3:46:59It's crucial damation. In the realm of
3:47:01nursing implications, timely handling of
3:47:04the sample is paramount. We must send
3:47:07the samples for analysis promptly to
3:47:09avoid any wastage or degradation. Also,
3:47:13monitoring lab values and understanding
3:47:15their implications for the patients care
3:47:17is a significant responsibility. It's
3:47:20like being a detective where lab results
3:47:22are clues to the patients health puzzle.
3:47:26Finally, postolction care is just as
3:47:29important. We need to provide the right
3:47:31care and monitoring to the patient,
3:47:34addressing any complications or concerns
3:47:36that arise. It's about ensuring the
3:47:39well-being of the patient throughout the
3:47:41entire process.
3:47:43Before we move ahead, let me take a
3:47:46quick moment to tell you something that
3:47:48could completely change your ENLEX
3:47:50journey. If you're serious about passing
3:47:52the ENLEX in just one week or even
3:47:54within a month, then the smartest move
3:47:56you can make right now is to enroll in
3:47:58our complete online ENLEX crash course.
3:48:00This isn't just another course. It's a
3:48:02shortcut, a clear step-by-step road map
3:48:04that has already helped over 100,000
3:48:06nursing students pass the ENCLEX with
3:48:07confidence. And here's the most
3:48:08incredible part. Not a single student
3:48:10who completed this course has failed.
3:48:12Yes, that's a 100% passing rate. We
3:48:15built this course based entirely on the
3:48:17feedback and insights of thousands of
3:48:18nurses who've successfully cleared the
3:48:20ENCLEs in the last 5 years. That means
3:48:22we've removed all the fluff and focused
3:48:23only on what truly matters for your
3:48:25exam. Here's exactly what you'll get
3:48:26when you enroll. You'll get 100 hours of
3:48:28animated crash course content designed
3:48:30for rapid revision, 500 hours of
3:48:32comprehensive recorded lectures covering
3:48:34all the high yield topics, and access to
3:48:3610,000 reallex questions to sharpen your
3:48:38test taking skills. You'll also get 500
3:48:40NextG case-based questions to strengthen
3:48:42your clinical judgment along with 15
3:48:44fulllength practice tests that simulate
3:48:46the real enclelex experience. And of
3:48:48course, you'll receive our complete
3:48:49Enclelex ebook and PDF notes, plus one
3:48:52full year of access so you can study at
3:48:53your pace on your schedule. And yes,
3:48:55we're currently offering a 70% discount
3:48:57for a very short period. Once the offer
3:48:59ends, it's gone. Thousands of students
3:49:01are enrolling in our online ENLEX course
3:49:02every month and passing the exam. But if
3:49:04you don't enroll now, you risk being
3:49:06left behind. Spots are filling fast and
3:49:08only a few seats are left. Visit our
3:49:10website to enroll now. Link is given in
3:49:11description box. Let's continue the
3:49:13video. The next topic is provision of
3:49:16safety for patients. This topic is
3:49:18particularly important from an exam
3:49:20perspective as the board is keen to
3:49:22assess how effectively a nurse can
3:49:24ensure the safety of patients in a
3:49:26hospital setting. Expect at least one
3:49:29question from this topic. So, watch
3:49:31carefully. Also, don't forget to
3:49:34subscribe to our channel. In the
3:49:35upcoming days, you'll have access to
3:49:37more than 100 videos to help you prepare
3:49:40for the ENCLEX exam. Now, let's begin
3:49:43this topic. First, we will discuss fire
3:49:46safety, specifically what a nurse should
3:49:49do in the event of a fire. In the event
3:49:52of a fire emergency, efficient
3:49:54management is crucial. The Monomic race
3:49:57is a helpful tool to remember the key
3:49:59actions. First, rescue clients who are
3:50:03in immediate danger. Next, activate the
3:50:06fire alarm. Then, confine the fire by
3:50:10closing doors and windows. And finally,
3:50:12if possible, extinguish the fire.
3:50:15Alongside this, the pass technique is
3:50:18vital for using a fire extinguisher
3:50:20effectively. Pull the pin, aim at the
3:50:23fire's base, squeeze the handle, and
3:50:27sweep the nozzle side to side. An
3:50:30uncluttered environment is also
3:50:32essential in such emergencies. Keeping
3:50:35open spaces free of clutter ensures
3:50:37unobstructed movement and access which
3:50:40can be life-saving. Equally important is
3:50:42the visibility and accessibility of fire
3:50:45exits which should always be clearly
3:50:47marked and unblocked. Familiarity with
3:50:51fire safety equipment and procedures is
3:50:53another key aspect. Everyone should be
3:50:56aware of the locations of fire alarms,
3:50:58exits, and extinguishers. Understand the
3:51:01contact number for reporting fires and
3:51:03bever in the standard fire drill and
3:51:05evacuation procedures of the agency. In
3:51:08a fire, elevators are a hazard and must
3:51:11never be used as they may become
3:51:13inoperative or dangerous. Instead,
3:51:17stairs should be used for evacuation.
3:51:19Regarding oxygen and electrical
3:51:21appliances, these should be turned off
3:51:23near a fire to reduce the risk of
3:51:25exacerbation.
3:51:26When dealing with clients on life
3:51:28support, their respiratory status should
3:51:31be maintained manually with a
3:51:32resuscitation bag or ambu bag until they
3:51:35can be safely moved and reconnected to
3:51:38life support. Evacuation procedures vary
3:51:41based on the mobility of clients.
3:51:43Ambulatory clients should be directed to
3:51:45safe areas, possibly assisting in moving
3:51:48clients in wheelchairs, while bedridden
3:51:50clients should be evacuated using
3:51:52stretchers, beds, or wheelchairs,
3:51:54employing appropriate transfer
3:51:56techniques to ensure safety. Finally, in
3:52:00situations where the fire department
3:52:02personnel are present, they will provide
3:52:04assistance in evacuating clients.
3:52:06Regularly reviewing and memorizing the
3:52:08race and passomics is essential to
3:52:11ensure prompt and effective responses
3:52:14during a fire, prioritizing safety and
3:52:17minimizing harm. For electrical safety,
3:52:20it's important to maintain all
3:52:22electrical equipment in good working
3:52:23order and ensure they are properly
3:52:25grounded to prevent hazards. Always use
3:52:28three-pronged electrical cords where the
3:52:31third longer prong acts as a ground and
3:52:33the other two prongs carry power.
3:52:36Regularly inspect electrical cords and
3:52:38outlets for any signs of exposed,
3:52:40frayed, or damaged wires. Overloading
3:52:44circuits should be avoided to prevent
3:52:45potential accidents. Understanding and
3:52:48following the warning labels on all
3:52:50equipment is crucial, and one should
3:52:52never operate equipment that is
3:52:54unfamiliar. When using safety extension
3:52:56cords, they should only be used when
3:52:58absolutely necessary, and they should be
3:53:01securely taped to the floor with
3:53:02electrical tape. Electrical wiring
3:53:05should never be run under carpets for
3:53:07safety reasons. When unplugging any
3:53:09device, it's important to grasp the plug
3:53:12itself rather than pulling on the cord.
3:53:15Electrical appliances should never be
3:53:16used near sinks, bathtubs, or other
3:53:19water sources to avoid electrocution
3:53:21risks. Before cleaning any electrical
3:53:24equipment or appliances, always
3:53:26disconnect the plug from the outlet. In
3:53:28the event of an electrical shock to a
3:53:30client, the first step is to turn off
3:53:32the electricity before touching the
3:53:34client to ensure safety of both the
3:53:37rescuer and the victim. In terms of
3:53:39radiation safety, knowing and adhering
3:53:42to the protocols and guidelines of the
3:53:44healthcare agency is essential. Any
3:53:46potentially radioactive material should
3:53:48be clearly labeled. To reduce exposure
3:53:51to radiation, limit the time spent near
3:53:54the source. Make the distance from the
3:53:56source as great as possible and use
3:53:58shielding devices such as lead aprons.
3:54:01Radiation exposure should be monitored
3:54:03with a dosometer badge. Clients who have
3:54:05radiation implants should be placed in a
3:54:08private room. In the event that a
3:54:10radiation implant is dislodged, it
3:54:12should never be touched and all linens
3:54:15should remain in the client's room until
3:54:17the implant is removed. When disposing
3:54:20of infectious wastes, all infectious
3:54:23material should be handled as hazardous.
3:54:26Waste should be disposed of only in
3:54:28designated areas using the proper
3:54:30containers for disposal. It's crucial
3:54:32that infectious material is labeled
3:54:34properly. All sharps like needles should
3:54:38be disposed of immediately after use in
3:54:40closed punctureresistant disposable
3:54:42containers that are leakproof and either
3:54:45labeled or colorcoded. Needles should
3:54:48not be recapped, bent or broken due to
3:54:51the risk of accidental injury such as
3:54:53needle sticks. Each of these practices
3:54:56plays a vital role in ensuring safety in
3:54:58a health care setting both for the
3:55:00healthcare providers and the patients.
3:55:03It's important to regularly reinforce
3:55:05these practices through training and
3:55:07practical demonstrations to maintain a
3:55:10safe working environment.
3:55:12Preventing falls in a healthcare setting
3:55:14involves a comprehensive approach
3:55:16focused on assessing and managing the
3:55:18risk for each client. The first step is
3:55:21to assess the client's risk for falling,
3:55:24which allows for tailored preventive
3:55:26measures. Clients identified as being at
3:55:28risk should ideally be assigned to rooms
3:55:31close to the nurse's station for easier
3:55:33monitoring. It's also important to make
3:55:35all personnel aware of the client's risk
3:55:37for falling to ensure vigilant care.
3:55:40Frequent assessment of the client is
3:55:42crucial alongside orienting them to
3:55:45their physical surroundings to minimize
3:55:46confusion. Clients should be instructed
3:55:49to seek assistance when getting up,
3:55:51emphasizing the importance of not
3:55:53attempting to move unaided. Educating
3:55:55the client on the use of the nurse call
3:55:57system provides them with a way to
3:55:59easily request help. The use of safety
3:56:02devices such as floor pads and alarms
3:56:05for beds or chairs plays a significant
3:56:07role. These alarms alert healthare
3:56:10personnel when a person attempts to get
3:56:12out of bed or a chair, enabling prompt
3:56:15assistance. Ensuring that beds are kept
3:56:17in the low position with side rails
3:56:19adjusted according to the AY's policy is
3:56:22another key preventive measure.
3:56:24Additionally, locking all beds,
3:56:26wheelchairs, and stretchers prevents
3:56:28accidental movement that could lead to
3:56:30falls.
3:56:32Accessibility is another factor to
3:56:34consider. Keeping clients personal items
3:56:37within easy reach and eliminating
3:56:38clutter and obstacles in their room can
3:56:41significantly reduce fall risks.
3:56:43Providing adequate lighting, especially
3:56:45during nighttime, helps clients navigate
3:56:48their surroundings safely. Addressing
3:56:50bathroom hazards is equally important as
3:56:53many falls occur in this area. This
3:56:56involves maintaining a regular toileting
3:56:58schedule for the client throughout the
3:57:00day to minimize the urgency and
3:57:02frequency of unsupervised bathroom
3:57:04visits. By integrating these measures,
3:57:07healthcare facilities can significantly
3:57:09reduce the incidence of falls, ensuring
3:57:12a safer environment for their clients.
3:57:15Before we move ahead, let me take a
3:57:16quick moment to tell you something that
3:57:18could completely change your enclelex
3:57:21journey. If you're serious about passing
3:57:22the ENLEX in just one week or even
3:57:24within a month, then the smartest move
3:57:26you can make right now is to enroll in
3:57:28our complete online ENLEX crash course.
3:57:31This isn't just another course, it's a
3:57:32shortcut. A clear step-by-step road map
3:57:34that has already helped over 100,000
3:57:36nursing students pass the ENCLEX with
3:57:37confidence. And here's the most
3:57:38incredible part. Not a single student
3:57:41who completed this course has failed.
3:57:42Yes, that's a 100% passing rate. We
3:57:45built this course based entirely on the
3:57:47feedback and insights of thousands of
3:57:48nurses who've successfully cleared the
3:57:50enclelex in the last 5 years. That means
3:57:52we've removed all the fluff and focused
3:57:54only on what truly matters for your
3:57:55exam. Here's exactly what you'll get
3:57:56when you enroll. You'll get 100 hours of
3:57:58animated crash course content designed
3:58:00for rapid revision, 500 hours of
3:58:02comprehensive recorded lectures covering
3:58:04all the high yield topics, and access to
3:58:0610,000 real andlex questions to sharpen
3:58:08your test taking skills. You'll also get
3:58:10500 NextGen case-based questions to
3:58:12strengthen your clinical judgment along
3:58:14with 15 fulllength practice tests that
3:58:16simulate the real enclelex experience.
3:58:18And of course, you'll receive our
3:58:19complete Enclelex ebook and PDF notes,
3:58:22plus one full year of access so you can
3:58:23study at your pace on your schedule. And
3:58:25yes, we're currently offering a 70%
3:58:27discount for a very short period. Once
3:58:29the offer ends, it's gone. Thousands of
3:58:31students are enrolling in our online
3:58:32ENLEX course every month and passing the
3:58:34exam. But if you don't enroll now, you
3:58:36risk being left behind. Spots are
3:58:37filling fast and only a few seats are
3:58:39left. Visit our website to enroll now.
3:58:41Link is given in description box. Let's
3:58:43continue the video. Understanding crisis
3:58:45intervention.
3:58:47Crisis intervention involves addressing
3:58:49a temporary state of severe emotional
3:58:51disorganization resulting from failed
3:58:54coping mechanisms and insufficient
3:58:56support. In such situations, individuals
3:58:59may struggle with decision-m and problem
3:59:01solving abilities. The primary aim of
3:59:04treatment is to support both the client
3:59:06and their family through the challenging
3:59:08circumstances.
3:59:12Phases of crisis.
3:59:15The phases of a crisis typically unfold
3:59:17in a sequential manner. It begins with
3:59:20an external precipitating event followed
3:59:23by the perception of threat and an
3:59:25increase in anxiety. During this phase,
3:59:28the individual may either cope with or
3:59:30resolve the crisis. However, if coping
3:59:34mechanisms fail, the crisis progresses
3:59:36to a phase of increasing disorganization
3:59:39marked by the emergence of physical
3:59:41symptoms and relationship problems. In
3:59:43the subsequent phase, efforts are made
3:59:46to mobilize internal and external
3:59:48resources with the goal of restoring the
3:59:50client to at least their precrisis level
3:59:53of functioning. Types of crises.
3:59:57Various types of crises exist, each with
4:00:00its own unique characteristics.
4:00:03Maturational crises stem from
4:00:05developmental stages and associated role
4:00:07changes such as marriage or retirement.
4:00:11Situational crises arise from external
4:00:13sources, disrupting psychological
4:00:15equilibrium due to life events like job
4:00:18loss, financial changes, or the death of
4:00:20a loved one. Adventitious crises, on the
4:00:24other hand, result from disasters or
4:00:26events outside of everyday life, such as
4:00:29natural disasters, acts of terrorism, or
4:00:32war.
4:00:34Approaches in crisis intervention.
4:00:37In crisis intervention, immediate and
4:00:40supportive treatment is provided to
4:00:42address the immediate crisis.
4:00:44Interventions are goal-directed,
4:00:46acknowledging the client's feelings and
4:00:48providing opportunities for expression
4:00:50and validation. Moreover, connections
4:00:53are made between the events meaning and
4:00:55the crisis, allowing the client to
4:00:58explore alternative coping mechanisms
4:01:00and adopt new behaviors.
4:01:03Let's start the next topic that is
4:01:05grief. Grief, a natural emotional
4:01:08response to loss, compels individuals to
4:01:11navigate through various stages or tasks
4:01:13in an attempt to come to terms with the
4:01:15absence. This process involves a journey
4:01:18through different emotional landscapes,
4:01:21each presenting its unique challenges
4:01:23and opportunities for healing.
4:01:28Stages of grief.
4:01:30Initially, during the stage of shock and
4:01:33disbelief, the survivor grapples with
4:01:35numbness and disbelief, often leading to
4:01:38difficulties in decision-m and
4:01:40manifestations of denial or isolation.
4:01:43Moving forward, the experiencing the
4:01:45loss stage envelops the survivor in a
4:01:48whirlwind of emotions, including anger,
4:01:50guilt, and bargaining as they confront
4:01:53the reality of the absence. This stage
4:01:56is marked by the need to process the
4:01:58loss, often accompanied by feelings of
4:02:01sadness and depression. Transitioning
4:02:03into the reintegration stage, the
4:02:06survivor begins to reconcile with the
4:02:08loss, gradually reorganizing their life
4:02:11and integrating the absence into their
4:02:13reality. Despite the ongoing challenge
4:02:16of adapting to life without the loved
4:02:18one, there's a gradual acceptance and a
4:02:20determination to move forward while
4:02:23still cherishing memories.
4:02:28Types of grief.
4:02:30Beyond the stages of grief, different
4:02:32types of grief emerge, each with its
4:02:35nuances and challenges. Normal grief, a
4:02:38common experience, entails a process of
4:02:41resolution that can span months to
4:02:44years, encompassing physical, emotional,
4:02:48cognitive, or behavioral reactions.
4:02:51Anticipatory grief, on the other hand,
4:02:53precedes the loss and is often linked
4:02:56with acute, chronic or terminal
4:02:59illnesses, intensifying the emotional
4:03:01turmoil even before the actual loss
4:03:04occurs. Disenfranchised grief adds
4:03:08another layer of complexity arising when
4:03:10a loss cannot be openly acknowledged due
4:03:13to societal norms or definitions.
4:03:17Dysfunctional grief signals a prolonged
4:03:19struggle with emotional instability
4:03:22hindering progress towards coping with
4:03:24the loss effectively.
4:03:28Grief in different contexts.
4:03:31In children, grief manifests differently
4:03:34based on their developmental level,
4:03:36presenting unique challenges that
4:03:38require tailored approaches for support
4:03:40and understanding. Understanding these
4:03:43variations in grief allows for more
4:03:46effective interventions and support
4:03:48systems to aid individuals in navigating
4:03:51the complexities of loss and healing.
4:03:56Understanding loss and grief loss,
4:03:59whether actual, perceived, or
4:04:01anticipatory, embodies the absence of
4:04:04something desired or previously
4:04:06available. This absence can trigger a
4:04:09complex and multiaceted emotional
4:04:12response, commonly known as grief. Grief
4:04:16encompasses a range of emotions and
4:04:18behaviors experienced in response to
4:04:21loss, manifesting both internally and
4:04:24externally. types of loss. Actual loss
4:04:27is identifiable by others, arising in
4:04:30response to or anticipation of a
4:04:32situation, while perceived loss is
4:04:34subjective and cannot be verified
4:04:36externally. Anticipatory loss is
4:04:39experienced before its occurrence,
4:04:41adding a lay layer of complexity to the
4:04:44grieving process. Morning. Mourning the
4:04:47outward and social expression of loss is
4:04:50influenced by cultural and religious
4:04:53beliefs. It serves as a means for
4:04:55individuals to navigate their grief
4:04:57publicly and find solace within their
4:05:00communities. Bereerment. Bereerie
4:05:04encompasses both internal emotions and
4:05:06external reactions to loss, including
4:05:09grief and mourning. Understanding the
4:05:12multifaceted nature of bereiement is
4:05:14crucial in providing support to those
4:05:16experiencing loss.
4:05:19Nurses role in grief and loss.
4:05:23In the nurse's role concerning grief and
4:05:25loss, several key actions are essential.
4:05:28Firstly, the nurse must allow ongoing
4:05:31opportunities for fully informed
4:05:33choices, respecting the autonomy of the
4:05:35individual and their family.
4:05:38Additionally, facilitating the grief
4:05:40process involves assessing the
4:05:42survivor's emotions, and aiding them in
4:05:45completing the necessary tasks to
4:05:47navigate their grief. Recognizing that
4:05:50grief impacts individuals physically,
4:05:53psychologically, socially, and
4:05:55spiritually, a multidisciplinary
4:05:57approach, including bereiement
4:05:59specialists, can enhance the
4:06:01effectiveness of support interventions.
4:06:06Communication and support. In
4:06:09communication with clients, families,
4:06:11and significant others, nurses must
4:06:14consider various factors such as
4:06:16cultural background, religion, family
4:06:19dynamics, coping mechanisms, and support
4:06:22systems, sensitivity to personal
4:06:24boundaries, non-verbal cues, and the
4:06:27provision of emotional support are vital
4:06:29aspects of nursing care during times of
4:06:32grief. Encouraging the expression of
4:06:34feelings, actively listening, and
4:06:37offering reassurance are essential
4:06:39components of therapeutic communication.
4:06:42Nurses should also acknowledge their own
4:06:44emotions and be willing to share in the
4:06:46client's grief if appropriate.
4:06:50Hello, future nurses. Welcome to the
4:06:51Nursing Foundation Crash Course, your
4:06:53ultimate guide to enclelex success.
4:06:56We've packed this course with the most
4:06:58frequently tested topics on the
4:06:59enclelex. So after watching this, you
4:07:01won't need to go through multiple books.
4:07:03Plus, we've included important enclelex
4:07:06questions for every topic to sharpen
4:07:07your critical thinking. This video is a
4:07:09gold mine for your exam prep, so make
4:07:11sure to watch till the end. Let's get
4:07:13started. All right, let's go over
4:07:15ethical principles in nursing. First, we
4:07:17have veracity, which means being
4:07:19truthful. Nurses must always be honest
4:07:21when communicating with patients,
4:07:23families, and the healthare team. For
4:07:25example, if a patient is starting a new
4:07:27medication, the nurse should explain
4:07:28both the benefits and possible side
4:07:30effects, even if they're unpleasant.
4:07:32Next is justice, which means fair and
4:07:34equal treatment. Every patient should
4:07:36receive care based on their medical
4:07:38needs, not their background, race, or
4:07:41financial status. For instance, a nurse
4:07:44should prioritize patients based on
4:07:45urgency, not on whether they have
4:07:47insurance. Then we have accountability,
4:07:50which means accepting responsibility.
4:07:52Nurses must own their actions, including
4:07:54mistakes. If a nurse gives the wrong
4:07:56medication, they should immediately
4:07:57report it to their supervisor and
4:07:59complete an incident report. Taking
4:08:01responsibility helps ensure patient
4:08:03safety and trust. Now, let's talk about
4:08:06non-maleficence, which means do no harm.
4:08:10Nurses must always work to prevent harm
4:08:12and protect patients, especially those
4:08:14who are vulnerable. For example, raising
4:08:16bed rails for a confused elderly patient
4:08:18helps prevent falls. Moving on to
4:08:21fidelity, which is about loyalty and
4:08:23commitment. Nurses must keep their
4:08:25promises to patients. If a nurse tells a
4:08:27patient they'll bring pain medication at
4:08:29a certain time, they should follow
4:08:30through. Patients rely on that trust.
4:08:33Now, we have beneficence, which which
4:08:35means promoting good. Nurses should
4:08:37always act in the best interest of their
4:08:39patients. This can be as simple as
4:08:41providing emotional support to a patient
4:08:43who's dealing with a tough diagnosis.
4:08:45Now, let's test our understanding with
4:08:47an enclelex question. A nurse is
4:08:49educating a patient about a new
4:08:51medication. The patient asks if it has
4:08:53any side effects. What is the best
4:08:55response? A. There are no side effects
4:08:57at all. B. I cannot disclose that
4:09:01information.
4:09:02C. This medication may cause dizziness
4:09:05and nausea, but I will inform you how to
4:09:07manage it. D. Don't worry, you'll be
4:09:09fine. The correct answer is option C. It
4:09:12follows the principle of veracity by
4:09:14providing honest and helpful information
4:09:16to the patient. All right, uh, class,
4:09:19let's talk about informed consent.
4:09:20First, the surgeon's role. The surgeon
4:09:22must explain the diagnosis, procedure,
4:09:24risks, and alternatives. They also need
4:09:26to answer any questions the patient has,
4:09:28and ensure the patient fully understands
4:09:30before obtaining voluntary consent. Now,
4:09:33the nurse's role, the nurse witnesses
4:09:35the patient's signature, make sure the
4:09:37patient is competent and signing
4:09:38voluntarily, and documents the entire
4:09:40consent process. But what happens if
4:09:43additional procedures are needed during
4:09:45surgery? In that case, the medical power
4:09:47of attorney, next of kin or legal
4:09:49guardian must be contacted for consent.
4:09:51Now, let's check your understanding with
4:09:53an enclelex question. Which statement
4:09:55about informed consent is correct? A.
4:09:58The nurse is responsible for explaining
4:10:00the procedure. B. The nurse can obtain
4:10:03verbal consent over the phone? C. The
4:10:06nurse witnesses the signature but does
4:10:07not explain the procedure. D. The
4:10:10patient is forced to sign before
4:10:12surgery. Take a moment to think.
4:10:15The correct answer is C. The nurse's
4:10:17role is to witness the signature, not to
4:10:19explain the procedure. That's the
4:10:21surgeon's responsibility.
4:10:23Let's move on. Triage system. Triage is
4:10:26all about prioritizing patients based on
4:10:28the severity of their condition. In an
4:10:29emergency, not everyone can be treated
4:10:31at the same time. So, health care
4:10:33providers need to decide who gets help
4:10:35first and who can wait. The goal is
4:10:37simple. Save as many lives as possible
4:10:39while using resources wisely. Now, let's
4:10:42break it down into four categories.
4:10:44Emergent, red tag, immediate care
4:10:46needed. Think of this category as help
4:10:48them right now or they won't survive.
4:10:51These patients have life-threatening
4:10:52conditions, but if treated immediately,
4:10:54they have a good chance of survival. For
4:10:56example, if a patient has airway
4:10:58obstruction, they can't breathe and
4:11:00without oxygen, survival is impossible.
4:11:03This needs urgent intervention. Severe
4:11:05respiratory distress like intention
4:11:07pneumathorax where trapped air collapses
4:11:10a lung. This can quickly lead to death
4:11:12if untreated. Shock whether due to
4:11:15severe bleeding, hemorrhagic shock or
4:11:17infection spreading through the body.
4:11:19Sepsis needs rapid medical attention.
4:11:22Patients with major trauma like open
4:11:24fractures with bleeding need immediate
4:11:25stabilization. Active chest pain
4:11:28possibly due to a heart attack means
4:11:29time is critical. Every second counts.
4:11:32Stroke symptoms within 4.5 hours. This
4:11:35is the golden window for thrombolytic
4:11:36therapy which can dissolve clots and
4:11:38save brain function. Urgent yellow tag
4:11:41can wait a few hours. These patients are
4:11:43sick or injured, but stable for now.
4:11:46Their condition is serious, but it won't
4:11:47kill them immediately, so they can wait
4:11:49a little while. For example, a closed
4:11:51fracture without blood vessel or nerve
4:11:53damage doesn't need immediate surgery,
4:11:54but still requires treatment soon.
4:11:57Abdominal pain, such as appendicitis
4:11:59without rupture, is concerning, but as
4:12:01long as there's no perforation, it's not
4:12:03life-threatening.
4:12:05Moderate burns that don't affect the
4:12:06airway can be painful, but they don't
4:12:08need immediate intervention. Someone
4:12:10with high blood pressure, but no signs
4:12:12of organ damage should be treated, but
4:12:14it's not an emergency.
4:12:16Deep lacerations need stitches, but as
4:12:18long as bleeding is controlled, they can
4:12:20wait a few hours. Non-urgent green tag,
4:12:23minor injuries. These are the walking
4:12:26wounded. These patients are stable and
4:12:28their conditions won't get worse even if
4:12:29treatment is delayed for several hours.
4:12:32For example, minor burns, painful but
4:12:34not life-threatening, small lacerations,
4:12:36if they're not deep and bleeding is
4:12:38controlled, they can be stitched later.
4:12:41Sprains or minor fractures like a finger
4:12:43fracture don't need urgent care.
4:12:46Psychological distress, as long as the
4:12:48patient isn't at risk of harming
4:12:49themselves or others, they can wait.
4:12:51Expectant black tag, no chance of
4:12:54survival. This is the most difficult
4:12:56category. These are patients with
4:12:58injuries so severe that survival isn't
4:13:00possible given the resources available.
4:13:02In a mass casualty situation, the focus
4:13:04has to be on those who can be saved. For
4:13:07example, a patient with severe head
4:13:09trauma who doesn't respond to painful
4:13:11stimuli has a very poor prognosis.
4:13:13Someone with extensive full thickness
4:13:15burns covering most of their body is
4:13:17unlikely to survive. Massive trauma such
4:13:20as decapitation or a patient in cardiac
4:13:22arrest with no vital signs for a long
4:13:24time means survival is not possible. Now
4:13:27let's go through some practice
4:13:29questions. A hospital is responding to a
4:13:31mass casualty event after a bus crash.
4:13:34There are multiple injured patients and
4:13:36the medical team needs to decide who
4:13:38should be treated first. Which patient
4:13:40should receive immediate attention? A. A
4:13:4250-year-old with an open femur fracture
4:13:44and stable vitals. B. A 23-year-old with
4:13:48burns covering 90% of the body and no
4:13:50palpable pulse. C. A 34 year old with
4:13:54paradoxical chest movement and cyanosis.
4:13:56D. A 42-year-old with a sprained ankle
4:13:59and minor lacerations. Correct answer is
4:14:02option C. A 34year-old with paradoxical
4:14:05chest movement and cyanosis. Let's break
4:14:07this down. The key phrase here is
4:14:09paradoxical chest movement and cyanosis.
4:14:12This suggests flail chest, which can
4:14:14quickly lead to respiratory failure. If
4:14:16the airway is compromised, the patient
4:14:18needs immediate intervention to survive.
4:14:20This makes them a red tag, emerent
4:14:23priority. Now, let's go over why the
4:14:25other choices are not the highest
4:14:26priority. Option A, open femur fracture
4:14:29with stable vitals is serious, but not
4:14:31immediately life-threatening. This
4:14:33patient is a yellow tag, urgent, and can
4:14:35wait a little longer. Option B, 90%
4:14:38burns, no pulse, means the patient has
4:14:41little to no chance of survival. So they
4:14:43receive a black tag expectant, meaning
4:14:46resources should be focused on those who
4:14:48can be saved.
4:14:51Option D, sprained ankle and minor
4:14:53lacerations is clearly not
4:14:54life-threatening.
4:14:56This patient is stable, able to walk,
4:14:58and can wait several hours, making them
4:15:00a green tag, non-urgent. So in mass
4:15:03casualty situations, always prioritize
4:15:05airway and breathing first, which is why
4:15:08the patient with flail chest and
4:15:09cyanosis is treated immediately. Now
4:15:12let's look at another scenario. A
4:15:1567year-old patient with COPD comes to
4:15:18the emergency department. Which symptom
4:15:20indicates they need immediate
4:15:22intervention? A oxygen saturation 89% on
4:15:26room air? B. Barrel chest and clubbing?
4:15:29C. Sudden confusion and difficulty
4:15:31speaking. D. Mild shortness of breath
4:15:34with exertion. Answer C. Sudden
4:15:37confusion and difficulty speaking.
4:15:39Here's why. Sudden confusion and
4:15:41difficulty speaking suggest a
4:15:43neurological change which could indicate
4:15:45a stroke or severe CO2 retention
4:15:47hypercapnea crisis in a COPD patient.
4:15:50Both are life-threatening conditions
4:15:52requiring immediate intervention. That's
4:15:54why this patient is classified as red
4:15:56tag emerent priority is. Now let's go
4:15:59over the other choices. Option A, oxygen
4:16:01saturation 89% may sound concerning but
4:16:05for a COPD patient this is actually not
4:16:08critically low. Their body is adapted to
4:16:10lower oxygen levels. So this does not
4:16:12require immediate action. Option B,
4:16:15barrel, chest, and clubbing are chronic
4:16:17signs of COPD, meaning they have
4:16:19developed over time and do not indicate
4:16:21an emergency. Option D, mild shortness
4:16:24of breath with exertion is a common
4:16:27symptom of COPD, but does not signal an
4:16:30immediate crisis.
4:16:31So the takeaway here is sudden changes
4:16:34in mental status or breathing are red
4:16:36flags and these patients must be treated
4:16:39immediately. Now let's move on to a
4:16:42disaster setting. Imagine there's been a
4:16:45natural disaster and resources are
4:16:47extremely limited. The medical team must
4:16:49decide who receives treatment and who
4:16:51does not. In this situation, which
4:16:53patient should be classified as
4:16:54expectant black tag? A a 40-year-old
4:16:58with tension pneumthorax. B. A
4:17:0155year-old with thirdderee burns
4:17:03covering 80% of the body. C. A
4:17:0530-year-old with a closed femur
4:17:07fracture. D. A 70-year-old with an
4:17:10asthma exacerbation requiring
4:17:12nebulizers. Answer. B. A 55year-old with
4:17:16thirdderee burns covering 80% of the
4:17:19body. Let's think about this logically.
4:17:21Black tag expectant is given to patients
4:17:23who are not expected to survive even
4:17:25with treatment. In mass casualty or
4:17:28disaster settings, medical resources are
4:17:30limited. So care is focused on saving
4:17:32those who have the best chance of
4:17:34survival. Here's why the correct answer
4:17:36is option B. A patient with thirdderee
4:17:38burns over 80% of the body has a very
4:17:41low survival rate even with advanced
4:17:43medical care. In a disaster situation,
4:17:46the chances of saving this patient are
4:17:48almost zero. So they are classified as
4:17:50expectant black tag, meaning they
4:17:53receive comfort care, not aggressive
4:17:55treatment. Now let's see why the other
4:17:57choices are not black tag. Option A,
4:18:00tension pumothorax, red tag, emergent.
4:18:04This is life-threatening but treatable
4:18:05with a chest decompression. Option C,
4:18:09closed femur fracture. Yellow tag
4:18:12urgent. This is a serious injury but not
4:18:14life-threatening. The patient can wait
4:18:16for treatment. Option D, asthma
4:18:19requiring nebulizers, green or yellow
4:18:22tag. Depending on severity, this patient
4:18:25could be stable enough to wait and would
4:18:27not be classified as expectant. So, in
4:18:30disaster triage, the focus is on using
4:18:32resources wisely. If a patient has
4:18:34injuries that are beyond medical help,
4:18:37they are given a black tag, allowing
4:18:39medical teams to prioritize those who
4:18:41can be saved. Final triage tips for
4:18:43INLEX. Always prioritize airway,
4:18:46breathing, and circulation, ABCs. This
4:18:49helps determine who needs the most
4:18:50urgent care. Red tag, emergent patients
4:18:53are treated first because they have
4:18:55life-threatening conditions but can
4:18:57still be saved. Black tag, expectant
4:19:00patients receive comfort care. They are
4:19:02not the priority in resource limited
4:19:04situations. I if a patient is stable and
4:19:07able to walk, they get a green tag,
4:19:09minor injuries, because they can wait
4:19:11for care. Before moving to the next
4:19:13topic, I want to share something
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4:19:37Leadership styles play a crucial role in
4:19:39shaping team performance, patient
4:19:41outcomes, and workplace culture. One of
4:19:43the most rigid forms is autocratic
4:19:45leadership, authoritarian, where the
4:19:47leader makes all decisions without team
4:19:49input. This style is characterized by
4:19:51strict control and a lack of
4:19:52collaborative decision-making. While it
4:19:54may seem restrictive, it is highly
4:19:56effective in emergencies or high-risisk
4:19:58situations. For instance, during a
4:20:00cardiac arrest, a nurse leader swiftly
4:20:02delegates tasks without discussion to
4:20:04ensure immediate and efficient patient
4:20:06care. In contrast, democratic
4:20:09leadership, participative, fosters a
4:20:11more inclusive approach by encouraging
4:20:13team input and discussion.
4:20:16This leadership style promotes
4:20:18collaboration and shared decision-m
4:20:20leading to higher staff satisfaction.
4:20:23However, the downside is that it may
4:20:25slow down the decision-making process.
4:20:28A common example is when a nurse manager
4:20:30consults staff members before making
4:20:32changes to scheduling. This style is
4:20:34often tested in ANCLEX exams with
4:20:36questions such as a nurse leader
4:20:37encourages team input on a new patient
4:20:39safety protocol. Which leadership style
4:20:42is this? The correct answer is a
4:20:44democratic. On the other end of the
4:20:46spectrum, lessair leadership handsoff
4:20:49takes a minimalistic approach providing
4:20:51little direction or supervision. This
4:20:54style works best with highly skilled
4:20:56independent professionals who require
4:20:58little oversight. However, in teams with
4:21:00inexperienced members, it can lead to
4:21:02disorganization and inefficiency.
4:21:05An example of this is a nurse manager
4:21:07who tells staff, "You can handle things
4:21:10however you see fit, leaving decision-m
4:21:12entirely up to the team. For those
4:21:14aiming to inspire and drive positive
4:21:16change, transformational leadership is
4:21:18an ideal approach. This leadership style
4:21:21focuses on long-term goals, motivation,
4:21:24and professional development.
4:21:26Transformational leaders encourage
4:21:27innovation and mentorship, helping staff
4:21:29grow while improving patient care. A
4:21:31prime example is a nurse leader who
4:21:34actively promotes staff education and
4:21:36mentorship programs to enhance health
4:21:38care quality. Lastly, transactional
4:21:40leadership, rewards, and punishment,
4:21:42relies on a structured system of rewards
4:21:44and consequences to maintain order. This
4:21:47style is practical for managing
4:21:48day-to-day operations, but does not
4:21:50emphasize long-term growth or
4:21:52innovation. It works well in
4:21:54environments where clear guidelines and
4:21:56expectations are necessary. For
4:21:59instance,
4:22:02a nurse leader may offer bonuses for
4:22:04meeting patient satisfaction targets
4:22:05while issuing warnings for excessive
4:22:07tardiness. Let's discuss some questions.
4:22:09A nurse manager offers extra paid time
4:22:11off as an incentive for meeting
4:22:13infection control goals. Which
4:22:15leadership style is being used? A
4:22:17democratic, B transformational, C
4:22:19transactional, D leer. Answer C.
4:22:23Transactional.
4:22:25Let's move to the next question. In an
4:22:27emergency, a nurse leader takes full
4:22:28control, giving orders without
4:22:30consulting the staff. Which leadership
4:22:32style is being demonstrated? A.
4:22:35Democratic. B. Autocratic. C. Leair. D.
4:22:39Transformational. Answer. B. Autocratic.
4:22:42Now, let's look at another scenario. A
4:22:44nurse leader provides minimal
4:22:45supervision and allows staff to make
4:22:47most decisions. Which leadership style
4:22:49does this describe? A. Democratic B
4:22:52autocratic C lefair D transformational
4:22:56answer C Leifair. Wait before we move to
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4:23:23rate. Don't leave your success to
4:23:25chance. Enroll now. Personal protective
4:23:28equipment. PPE plays a crucial role in
4:23:30ensuring the safety of healthare workers
4:23:32and preventing the spread of infections.
4:23:34When putting on PPE, it is important to
4:23:37follow the correct sequence, which
4:23:38follows a reverse alphabetical order
4:23:40with one exception. The mask is put on
4:23:42second. The correct dawning sequence is
4:23:44gown first, followed by the mask, then
4:23:47goggles, and finally gloves. This order
4:23:49ensures maximum protection while
4:23:51minimizing contamination risks. On the
4:23:53other hand, when removing PPE, the
4:23:55process follows an alphabetical order to
4:23:57safely prevent self-contamination. The
4:24:00correct doing sequence is gloves first,
4:24:02followed by goggles, then the gown, and
4:24:04finally the mask. This method ensures
4:24:06that the most contaminated items are
4:24:08removed first while preventing exposure
4:24:11to harmful pathogens. To reinforce this
4:24:13concept, consider the following enclelex
4:24:16style question. A nurse is about to
4:24:18remove PPE after caring for a patient
4:24:20under contact precautions. What is the
4:24:22correct sequence? A. Mask, gloves, gown,
4:24:26goggles. B. Gloves, goggles, gown, mask.
4:24:29C. Goggles, mask, gown, gloves. D. Gown,
4:24:33goggles, mask, gloves. The correct
4:24:35answer is B. Gloves, goggles, gown,
4:24:38mask. As it follows the proper doawing
4:24:41sequence based on alphabetical order,
4:24:43ensuring safe removal and reducing the
4:24:44risk of contamination. Delegation in
4:24:47nursing is essential for ensuring
4:24:48efficient patient care while maintaining
4:24:50safety and adherence to professional
4:24:52roles. Registered nurses are responsible
4:24:54for assessing, teaching, evaluating, and
4:24:57managing unstable patients as these
4:24:59tasks require critical thinking and
4:25:01advanced clinical judgment. In contrast,
4:25:03licensed practical nurses primarily care
4:25:05for stable patients and administer
4:25:07medications except for introvenous push
4:25:10medications in most cases. Meanwhile,
4:25:12unlicensed assistive personnel focus on
4:25:14activities of daily living such as
4:25:16bathing, feeding, ambulation, and
4:25:18measuring vital signs in stable
4:25:20patients.
4:25:22Understanding these roles is crucial for
4:25:24making appropriate delegation decisions.
4:25:27To apply this knowledge, consider the
4:25:28following enclelex style question. Which
4:25:32task is appropriate to delegate to a
4:25:34UAP? A teaching a diabetic patient how
4:25:37to administer insulin. B. Assessing pain
4:25:40level in a post-op patient. C. Measuring
4:25:43a stable patients vital signs. D.
4:25:47Administering oral pain medication. The
4:25:49correct answer is C. Measuring a stable
4:25:51patients vital signs as this falls
4:25:54within the UAP's scope of practice.
4:25:57Tasks requiring assessment, education,
4:25:59or medication administration should not
4:26:01be delegated to UAPs.
4:26:04Another scenario further highlights the
4:26:06importance of proper delegation. An LPN
4:26:10is assigned a patient with newly
4:26:12diagnosed diabetes.
4:26:14Which task is most appropriate for the
4:26:16RN to perform? A. Administering insulin.
4:26:20B. Teaching the patient how to monitor
4:26:22blood glucose. C. Collecting a urine
4:26:24sample. D. Monitoring the patients oral
4:26:27intake. The correct answer is B.
4:26:29Teaching the patient how to monitor
4:26:31blood glucose as teaching falls under
4:26:33the RN's responsibilities.
4:26:36While LPNs and UAPs can assist with
4:26:38various tasks, patient education and
4:26:41evaluation require the expertise of an
4:26:43RN to ensure accurate understanding and
4:26:45safe management of the condition. Using
4:26:47a cane correctly is essential for
4:26:49maintaining balance and mobility,
4:26:51especially for individuals with weakness
4:26:53on one side of the body. The proper
4:26:56technique begins with holding the cane
4:26:57on the strong side, which provides
4:26:59better support and stability while
4:27:01walking. When moving, the cane should be
4:27:03advanced first, followed by the weak
4:27:05leg, and finally the strong leg stepping
4:27:07forward to complete the movement. This
4:27:09sequence ensures a steady gate and
4:27:11prevents falls. To reinforce this
4:27:13concept, consider the following enclelex
4:27:16style question. A nurse is teaching a
4:27:18patient with right-sided weakness how to
4:27:20use a cane. Which instruction is
4:27:23correct? A. Hold the cane in your right
4:27:26hand for better support? B. Move the
4:27:30cane and the strong leg together. C.
4:27:33Move the cane first, then the weak leg,
4:27:36followed by the strong leg. D. Move the
4:27:39strong leg first, then the cane and weak
4:27:41leg together. The correct answer is C.
4:27:43Move the cane first, then the weak leg,
4:27:46followed by the strong leg. This method
4:27:48provides the necessary stability and
4:27:49support, allowing the patient to walk
4:27:51safely while minimizing the risk of
4:27:53imbalance or falls. Prioritization in
4:27:56nursing is a fundamental skill that
4:27:58ensures patient safety by addressing the
4:28:00most critical conditions first. When
4:28:02prioritizing care, it is important to
4:28:04note that age and gender are not
4:28:07criteria for prioritization. Instead,
4:28:09nurses must focus on the severity and
4:28:11urgency of a patient's condition. In
4:28:14general, acute conditions take priority
4:28:16over chronic conditions as they pose an
4:28:18immediate threat to the patients health.
4:28:20Similarly, postoperative patients within
4:28:22the first 12 hours are prioritized over
4:28:24those beyond 12 hours as they are at
4:28:27higher risk for complications. A key
4:28:29concept in prioritization is
4:28:31distinguishing between stable and
4:28:33unstable patients. Stable patients who
4:28:35require lower priority include those
4:28:37with chronic illnesses, post-op recovery
4:28:39beyond 12 hours, local or regional
4:28:42anesthesia, or expected symptoms of a
4:28:44known disease. In contrast, unstable
4:28:46patients require immediate attention and
4:28:48include those with acute illnesses or
4:28:50injuries posttop recovery within the
4:28:52first 12 hours, general anesthesia, or
4:28:54unexpected symptoms. Additionally,
4:28:56certain conditions are always considered
4:28:58unstable and high priority, such as
4:29:00hemorrhage, high fevers exceeding 105°
4:29:03F, severe hypoglycemia, such as DKA,
4:29:07HHNS, and pulselessness or
4:29:09breathlessness, which necessitate
4:29:11immediate CPR. To further refine
4:29:14prioritization, problems are classified
4:29:17into three levels based on severity.
4:29:19First level prioritization involves
4:29:21life-threatening emergencies such as
4:29:23airway obstruction, respiratory
4:29:25distress, cardiac arrest, severe
4:29:27bleeding, and anaphilaxis. These require
4:29:30immediate intervention to prevent death.
4:29:34Second level prioritization includes
4:29:35serious but not immediately
4:29:37life-threatening conditions such as
4:29:38altered mental status, severe pain,
4:29:40acute urinary retention, uncontrolled
4:29:42blood sugar, and critical abnormal lab
4:29:44values such as dangerously high or low
4:29:47potassium levels. Finally, third level
4:29:49prioritization deals with long-term
4:29:51problems and routine care such as
4:29:53patient education, mobility issues, and
4:29:55psychosocial needs. To apply these
4:29:57concepts, consider the following
4:29:59enclelex style questions. A 72-year-old
4:30:02patient with chronic kidney disease
4:30:03reports mild leg swelling while a
4:30:0650-year-old patient has an active GI
4:30:08bleed. Who should the nurse see first?
4:30:10Answer is the 50-year-old patient with
4:30:12an active GI bleed. Since this is an
4:30:14unstable acute condition requiring
4:30:17immediate intervention.
4:30:19Next question is a nurse receives four
4:30:22patients. Which one should be seen
4:30:23first?
4:30:25A. A patient with pneumonia reporting
4:30:27mild shortness of breath. B. A posttop
4:30:30patient with a mild fever. A patient
4:30:32with a history of COPD experiencing
4:30:34severe dispia. D. A diabetic patient
4:30:37with a fasting blood sugar of 150 mg per
4:30:40deciliter. Correct answer is option C.
4:30:42The patient with severe dispnnea due to
4:30:44COPD as acute respiratory distress takes
4:30:47priority over other conditions. A
4:30:49modified radical mistctomy is a surgical
4:30:51procedure that involves the removal of
4:30:53the breast, axillary lymph nodes and
4:30:56superior apical nodes while preserving
4:30:58the chest muscles. This approach helps
4:31:00in managing breast cancer while
4:31:02maintaining some structural integrity of
4:31:03the chest. However, a significant
4:31:06postoperative concern is the risk of
4:31:08lympadeema, a condition caused by lymph
4:31:10fluid buildup due to the removal of
4:31:12lymph nodes. To prevent lympadeema,
4:31:14certain precautions must be followed.
4:31:16The affected arm should be kept elevated
4:31:18on pillows to promote proper drainage
4:31:20and reduce swelling. Additionally, it is
4:31:22crucial to avoid blood pressure
4:31:24measurements. Intravenous insertions or
4:31:26blood draws on the affected arm as these
4:31:28can increase the risk of complications.
4:31:30Proper postmastctomy positioning also
4:31:33plays a vital role in recovery. Patients
4:31:35should be positioned in semifer's
4:31:37position with the affected arm elevated
4:31:39to further aid in fluid drainage and
4:31:41prevent swelling. To reinforce this
4:31:43concept, consider the following.
4:31:45Enclelex style question. A postmastctomy
4:31:48patient is at risk for lympadeema. What
4:31:50should the nurse avoid? A. Elevating the
4:31:53arm on pillows. B. Applying compression
4:31:56bandages. C. Drawing blood from the
4:31:58affected arm. D. Encouraging hand and
4:32:01arm exercises. The correct answer is
4:32:03option C. Drawing blood from the
4:32:06affected arm as any medical procedures
4:32:08on the affected side can contribute to
4:32:09lympadeema and should be strictly
4:32:11avoided.
4:32:13Positioning clients for procedures.
4:32:15Proper patient positioning is essential
4:32:17for ensuring successful procedures and
4:32:19preventing complications. Different
4:32:21procedures require specific positions to
4:32:23optimize safety and effectiveness. For
4:32:25instance, patients undergoing
4:32:27paracentesis should be placed in high
4:32:28fowlers position as this allows fluid to
4:32:30accumulate in the lower abdomen for
4:32:33easier drainage. In cases of suspected
4:32:35air embolism, trendelenberg position is
4:32:37recommended to trap the embolism in the
4:32:39right ventricle and prevent it from
4:32:41traveling to the brain or lungs. For
4:32:43chest tube placement, raising the arms
4:32:45above the head helps expand the rib cage
4:32:47and provides better access to the
4:32:48insertion site. After a liver biopsy,
4:32:52patients should be positioned on their
4:32:53right side to apply pressure to the
4:32:55puncture site, minimizing the risk of
4:32:57bleeding. Meanwhile, for thorosentesis,
4:32:59an upright position with the patient
4:33:01leaning forward allows for better lung
4:33:03expansion and facilitates fluid removal.
4:33:06To reinforce this concept, consider the
4:33:08following endlex style question. A
4:33:11patient just had a liver biopsy. How
4:33:13should they be positioned? A on their
4:33:16left side, B on their right side, C
4:33:18supine, D in high fowlers. The correct
4:33:21answer is option B on their right side.
4:33:23as this position helps prevent bleeding
4:33:25by applying pressure to the biopsy site.
4:33:27Jehovah's Witness patients. Caring for
4:33:30Jehovah's Witness patients requires
4:33:32understanding their religious beliefs
4:33:33regarding medical treatment. One of
4:33:35their fundamental principles is the
4:33:37refusal of blood transfusions even in
4:33:39life-threatening situations. However,
4:33:41they can accept IV fluids such as normal
4:33:44saline and lactated ringers which help
4:33:46maintain circulation without violating
4:33:48their religious beliefs. Additionally,
4:33:51they may receive a poet alpha, a
4:33:54medication that stimulates red blood
4:33:55cell production as an alternative to
4:33:57blood transfusion. To apply this
4:34:00knowledge, consider the following
4:34:01enclelex style question. A Jehovah's
4:34:04Witness patient has severe anemia. What
4:34:06treatment is appropriate? A blood
4:34:08transfusion. B normal saline infusion. C
4:34:11platelet transfusion. D administer
4:34:14epoetin alpha. The correct answer is D.
4:34:16administer a poet alpha as it enhances
4:34:19red blood cell production without the
4:34:20need for a transfusion aligning with the
4:34:22patients beliefs.
4:34:25Good Samaritan law. The Good Samaritan
4:34:27law protects health care providers from
4:34:29civil liability when they render
4:34:31emergency care outside of a clinical
4:34:33setting. This legal protection applies
4:34:36as long as the care is provided in good
4:34:37faith and without gross negligence.
4:34:39However, it is crucial that the provider
4:34:42acts within their scope of practice and
4:34:43follows standard medical guidelines.
4:34:46Importantly, nurses cannot accept
4:34:48payment for services rendered under the
4:34:49Good Samaritan law as it is intended to
4:34:52encourage voluntary assistance in
4:34:54emergencies. For example, if a nurse
4:34:56witnesses a car accident and performs
4:34:58CPR on an unresponsive victim resulting
4:35:00in broken ribs, the nurse is protected
4:35:03from legal consequences because the care
4:35:04was given in an emergency in good faith
4:35:07and without negligence. To test this
4:35:10understanding, consider the following
4:35:11enclelex style question. A nurse driving
4:35:14home witnesses an elderly man collapse
4:35:16on the sidewalk. The nurse initiates CPR
4:35:19and continues until EMS arrives. Which
4:35:22statement is true regarding the nurse's
4:35:24legal protection under the Good
4:35:25Samaritan law? A. The nurse can be held
4:35:29liable if the man does not survive? B.
4:35:31The nurse must accept payment from the
4:35:33family for the provided care.
4:35:35C. The nurse is protected as long as
4:35:37they acted within their scope of
4:35:39practice. D. The nurse should have
4:35:41waited for EMS to arrive before
4:35:43intervening. The correct answer is C.
4:35:45The nurse is protected as long as they
4:35:47acted within their scope of practice,
4:35:49ensuring that emergency care is provided
4:35:51safely and ethically. Abuse reporting.
4:35:54Nurses have a legal obligation to report
4:35:56any suspected or confirmed cases of
4:35:58abuse. This responsibility ensures the
4:36:00protection of vulnerable individuals,
4:36:02especially children who may not be able
4:36:04to advocate for themselves. Child abuse
4:36:07can occur at any age, but it is
4:36:08particularly common in infants and
4:36:10toddlers due to their dependence on
4:36:11caregivers. In many cases, perpetrators
4:36:14of child abuse struggle with low
4:36:15self-esteem and often have a history of
4:36:18growing up in domestic violence, making
4:36:20abuse a recurring cycle. Additionally,
4:36:22substance abuse is a common contributing
4:36:24factor among those who commit child
4:36:26abuse, further increasing the risk of
4:36:28harm. For instance, if a nurse notices
4:36:31multiple bruises on a child's arms and
4:36:33back during a routine checkup, and the
4:36:35parent casually states they just fall a
4:36:37lot, the nurse is legally required to
4:36:40report the situation for further
4:36:41investigation. Failure to report could
4:36:43result in continued harm to the child.
4:36:46To reinforce this concept, consider the
4:36:49following ANCLEX style question. A nurse
4:36:52in the pediatric unit notices bruises in
4:36:54various stages of healing on a child's
4:36:56body. What is the best nursing action?
4:37:00A. Confront the parents about the
4:37:02bruises and demand an explanation. B.
4:37:06Document the findings and report the
4:37:08suspected abuse to child protective
4:37:09services. C. Ask the child to describe
4:37:13how the bruises occurred and take no
4:37:15further action.
4:37:17D. Notify the physician only if the
4:37:20child confirms being physically abused.
4:37:22The correct answer is option B. Document
4:37:25the findings and report the suspected
4:37:26abuse to child protective services. This
4:37:29ensures proper intervention and protects
4:37:31the child from further harm. Advanced
4:37:34care planning. Advanced care planning is
4:37:36a crucial process that helps individuals
4:37:38determine their future health care
4:37:39preferences in case they become unable
4:37:41to make medical decisions. This planning
4:37:43includes two key components, a health
4:37:45care proxy and a living will. A
4:37:48healthcare proxy, also known as a
4:37:49durable power of attorney for health
4:37:51care, is a designated person who makes
4:37:53medical decisions on behalf of the
4:37:54patient. Meanwhile, a living will or
4:37:57advanced directive is a written document
4:37:59that outlines specific medical
4:38:00treatments the person wishes to accept
4:38:02or refuse in certain situations. It is
4:38:05important to note that providing oxygen
4:38:07via nasal canula is considered a comfort
4:38:09measure, not a resuscitation method.
4:38:12Therefore, it can still be administered
4:38:14to a patient even if they have a do not
4:38:16resuscitate DNR order. For example, if a
4:38:20terminally ill cancer patient with a DNR
4:38:22order is experiencing shortness of
4:38:24breath, the nurse can provide oxygen as
4:38:26it enhances comfort without violating
4:38:28the patients end of life wishes. To
4:38:30apply this concept, consider the
4:38:32following enclelex style question. A
4:38:35patient has a living will stating they
4:38:37do not want mechanical ventilation. The
4:38:40healthcare provider suggests intubation
4:38:42for respiratory distress. What is the
4:38:44nurse's priority action? A. Follow the
4:38:46physician's order and prepare for
4:38:48intubation. B. Verify the living will
4:38:51and discuss the patients wishes with the
4:38:53health care provider. C. Inform the
4:38:55patient that intubation is necessary and
4:38:58cannot be refused. D. Ignore the living
4:39:01will and allow the family to make the
4:39:03decision. The correct answer is option
4:39:06B. verify the living will and discuss
4:39:09the patients wishes with the healthcare
4:39:10provider. This ensures the patients
4:39:12autonomy is respected while also
4:39:14facilitating ethical decision-making in
4:39:16their care. Local organ procurement
4:39:19services play a vital role in
4:39:20coordinating organ donations and must be
4:39:22notified for every clinical death as per
4:39:25hospital protocol. During this process,
4:39:27cardiac and respiratory support must be
4:39:29maintained while organ donation is
4:39:31discussed or performed, ensuring the
4:39:34viability of the organs for
4:39:35transplantation. One critical aspect of
4:39:38organ donation is that family consent is
4:39:40not required if the patient is a
4:39:41registered organ donor. The patients
4:39:44prior decision takes precedence
4:39:45reinforcing the ethical and legal
4:39:47importance of respecting their wishes.
4:39:50Additionally, concerns about post-mortem
4:39:51appearance are unnecessary because organ
4:39:54donation does not disfigure the body,
4:39:56allowing funeral arrangements to proceed
4:39:58as usual without any visible
4:40:00alterations. For instance, consider the
4:40:02scenario where a brain deadad patient
4:40:03has assigned organ donor card, but the
4:40:06family refuses to proceed with the
4:40:07donation. In this case,
4:40:13the hospital must honor the patients
4:40:14document consent as their decision
4:40:16legally and ethically overrides the
4:40:18family's objections. A Nackllex style
4:40:21question highlights this principle. A
4:40:23patient is declared brain dead and is a
4:40:25registered organ donor. The family
4:40:27refuses to consent to organ donation.
4:40:30What is the best nursing action?
4:40:32A. Respect the family's wishes and
4:40:35cancel the donation. B. Inform the
4:40:38family that the patients prior consent
4:40:39allows organ donation to proceed. C.
4:40:42Wait until the family changes their mind
4:40:44before proceeding. D. Contact the legal
4:40:48team to obtain a court order for organ
4:40:50donation. The correct answer is option
4:40:52B. Inform the family that the patients
4:40:54prior consent allows organ donation to
4:40:56proceed, ensuring that the patients
4:40:59wishes are fulfilled while maintaining
4:41:00legal and ethical standards. Before we
4:41:03dive into the next topic, here's a game
4:41:04changer for your Enclelex prep. Our
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4:41:29Secure your spot today. Now we will
4:41:31discuss about arterial blood gas
4:41:33interpretation is an essential
4:41:34diagnostic tool used to assess a
4:41:36patients oxygenation, ventilation and
4:41:38acid base balance. Proper analysis helps
4:41:40in identifying respiratory and metabolic
4:41:43disturbances guiding appropriate
4:41:45treatment strategies. To determine the
4:41:47type of acid base imbalance, a simple
4:41:49rule applies. If pH and bicarbonate move
4:41:52in the same direction, both increasing
4:41:54or both decreasing, it indicates a
4:41:56metabolic imbalance. However, if pH and
4:42:00CO2 move in opposite directions, the
4:42:01cause is respiratory in nature.
4:42:03Understanding these patterns allows for
4:42:05quick identification of underlying
4:42:07conditions affecting acidbased
4:42:08homeostasis.
4:42:10The key components of an AG and their
4:42:12normal values are as follows. PH 7.35 to
4:42:167.45.
4:42:18Partial pressure of CO2 35 to 45 mm of
4:42:22mercury. Bicarbonate 22 to 26 mill
4:42:25equivalents per liter. Partial pressure
4:42:27of O2 80 to 100 millimeters of mercury.
4:42:31Oxygen saturation greater than 95%
4:42:35changes in pH significantly impact the
4:42:37body leading to specific symptoms. When
4:42:40pH increases means alkalossis occurs the
4:42:42patient may become irritable,
4:42:44hyperexitable, restless and tacocartic.
4:42:47A classic example is anxietyinduced
4:42:49hyperventilation leading to respiratory
4:42:52alkalossis. Additionally in alkalossis
4:42:54potassium levels drop causing
4:42:56hypocalemia.
4:42:58Conversely when pH decreases means
4:43:00acidosis occurs the patient may present
4:43:02with lethargy, weakness, brady cardia
4:43:05and obtundation. A common cause is
4:43:08chronic obstructive pulmonary disease
4:43:10which leads to CO2 retention resulting
4:43:13in respiratory acidosis. Unlike
4:43:15alkalossis, acidosis is associated with
4:43:17hypercalemia due to the shift of
4:43:19potassium out of cells. Respiratory
4:43:21versus metabolic imbalances. Respiratory
4:43:24alkalossis occurs when the pH increases
4:43:26and carbon dioxide levels decrease.
4:43:28Occurs due to hyperventilation which may
4:43:30result from anxiety, pain, pulmonary
4:43:33embolism, PE or high altitude exposure.
4:43:36Patients often experience tacipa,
4:43:38dizziness, tingling and tetany.
4:43:41Management involves slowing the
4:43:42breathing rate such as using a paper bag
4:43:44method for anxiety related cases and
4:43:47addressing the underlying cause.
4:43:50Respiratory acidosis occurs when the pH
4:43:52decreases and carbon dioxide levels
4:43:54increase. Is caused by hypoventilation
4:43:57leading to CO2 retention. Common causes
4:44:00include COPD, narcotic overdose, and
4:44:03airway obstruction. Symptoms range from
4:44:05confusion and lethargy to decreased
4:44:07respiratory drive. Treatment focuses on
4:44:10improving ventilation, oxygen therapy,
4:44:12and using broncoilators when necessary.
4:44:15Metabolic alkalossis occurs when the pH
4:44:17increases and bicarbonate levels rise
4:44:20results from acid loss commonly due to
4:44:22vomiting, nasogastric ng suctioning or
4:44:26diuretic use. Symptoms include
4:44:28hypocalemia, muscle cramps and cardiac
4:44:30arhythmias. Management involves treating
4:44:33the underlying cause and replacing
4:44:34electrolytes to restore balance.
4:44:36Metabolic acidosis occurs when the pH
4:44:38decreases and bicarbonate or HCO3 dash
4:44:41also decreases occurs due to excess acid
4:44:43production or bicarbonate loss. Common
4:44:46causes include diarrhea, HCO3 loss,
4:44:49diabetic ketoacidosis, DKA, lactic
4:44:52acidosis, shock, sepsis and renal
4:44:54failure. Patients may present with
4:44:57cusmol respirations, deep rapid
4:44:59breathing, hypercalemia and confusion.
4:45:01Treatment depends on the cause. insulin
4:45:04for DKA, IV fluids for dehydration, and
4:45:07dialysis for renal failure by following
4:45:09a systematic approach, examining pH
4:45:11first, then identifying whether PCO2 or
4:45:14HCO3
4:45:16is responsible. You can determine the
4:45:18underlying condition. A 45-year-old
4:45:20patient with COPD presents with
4:45:22confusion and lethargy. The AG results
4:45:25are pH 7.28 28 low indicating acidosis.
4:45:30Paka O2 55 mm of mercury high suggesting
4:45:34CO2 retention and a respiratory cause.
4:45:37HCO3 24 mill equivalents per liter
4:45:41normal ruling out a metabolic issue.
4:45:44Given these findings, the most likely
4:45:45acid base imbalance is A. Metabolic
4:45:48acidosis, B metabolic alkalossis, C
4:45:52respiratory acidosis, D respiratory
4:45:55alkalossis. Answer C. Respiratory
4:45:57acidosis. Since the pH is low, the
4:46:00patient has acidosis. The elevated PCO2
4:46:02indicates that the acidosis is due to
4:46:04CO2 retention, a hallmark of respiratory
4:46:07acidosis commonly seen in COPD patients
4:46:09who have difficulty expelling carbon
4:46:11dioxide. A patient experiencing severe
4:46:14vomiting for 3 days presents with the
4:46:15following AG results.
4:46:18PH 7.49 high indicating alkalossis.
4:46:23PCO2 42 mm of mercury normal meaning the
4:46:27issue is not respiratory. HCO3
4:46:30mill equivalents per liter high
4:46:32suggesting a metabolic cause. Based on
4:46:35these values the most likely cause of
4:46:36this imbalance is A diabetic keto
4:46:39acidosis B hyperventilation C excessive
4:46:43NG suctioning D narcotic overdose.
4:46:46Answer C excessive NG suctioning. Since
4:46:49the pH is high the patient has
4:46:51alkalossis. The elevated HCO3 dash
4:46:54confirms a metabolic origin. Vomiting
4:46:56and NG suctioning remove gastric acid
4:46:59leading to metabolic alkyossis due to
4:47:01excessive acid loss. Question three. A
4:47:04patient with sepsis presents with
4:47:05confusion and deep rapid breathing.
4:47:07Cousmal respirations. The AG results are
4:47:11pH 7.30
4:47:14low indicating acidosis. PCO2 33 mm of
4:47:18mercury low suggesting the lungs are
4:47:21compensating. HCO3 18 mill equivalents
4:47:25per liter low pointing to a metabolic
4:47:27issue. Which condition is most likely? A
4:47:31respiratory acidosis. B metabolic
4:47:34acidosis. C metabolic alkalossis. D
4:47:37respiratory alkalossis. Answer B.
4:47:40Metabolic acidosis. The low pH confirms
4:47:43acidosis and the low HCO3 dash indicates
4:47:46a metabolic cause. The PCO2 is also low
4:47:49showing that the body is compensating
4:47:51with cousal respirations, a deep and
4:47:53rapid breathing pattern typical in
4:47:54metabolic acidosis seen in conditions
4:47:56like sepsis.
4:47:59Final tip for enclelex.
4:48:01If partial pressure of carbon dioxide is
4:48:04abnormal, the problem is respiratory.
4:48:07If bicarbonate is abnormal, the problem
4:48:09is metabolic. Always analyze the pH
4:48:12first, then determine whether the issue
4:48:13is related to CO2 or bicarbonate to
4:48:16correctly identify the imbalance. The
4:48:18cranial nerves play a vital role in
4:48:20sensory and motor functions, and their
4:48:22assessment is crucial in identifying
4:48:23neurological abnormalities.
4:48:26The olfactory nerve, also known as
4:48:28cranial nerve 1, is a sensory nerve
4:48:30responsible for the sense of smell. To
4:48:33assess its function, one nostril is
4:48:35oluded at a time, and the patient is
4:48:37asked to identify familiar aromomas such
4:48:39as coffee, vanilla, or peppermint. A
4:48:42loss of smell, also called a nausemia,
4:48:44can indicate neurological conditions
4:48:45like Parkinson's disease or a head
4:48:47injury. Next, the optic nerve, also
4:48:50known as cranial nerve 2, controls
4:48:52visual acuity and pupil reaction. It is
4:48:55assessed using the Snellan chart where
4:48:57the patient reads at a distance of 20 ft
4:49:00keeping their glasses on except for
4:49:01reading glasses. Additionally, pupils
4:49:04equal, round, reactive to light and
4:49:06accommodation abbreviated as P R A is
4:49:10checked. Damage to the optic nerve can
4:49:12result in vision loss or blurring
4:49:14commonly seen in conditions like
4:49:15glaucoma and optic nitis. The ocular
4:49:18motor nerve also known as cranial nerve
4:49:203 is responsible for vertical eye
4:49:22movement and pupil constriction. It is
4:49:25tested by asking the patient to track an
4:49:27object moving up and down while also
4:49:29using a pen light to check pupil
4:49:31reaction. If damaged, it may lead to
4:49:34drooping of the eyelid, also calledtosis
4:49:37or fixed dilated pupils. Similarly, the
4:49:40tlear nerve, also known as cranial nerve
4:49:424, controls downward and inward eye
4:49:45movement and is assessed by tracking an
4:49:47object in those directions. A lesion in
4:49:49this nerve can cause double vision, also
4:49:52called dipopia. specifically vertical
4:49:55dipopia. The trigeminal nerve, also
4:49:57known as cranial nerve five, is a mixed
4:50:00nerve responsible for facial sensation
4:50:02and mastication, which means chewing.
4:50:04Assessment includes a light touch test
4:50:06on the forehead, cheeks, and chin with
4:50:08the patients eyes closed along with
4:50:10palpation of the temporal and massitor
4:50:12muscles while they clench their teeth.
4:50:14Damage to this nerve can result in
4:50:16trigeminal neuralgia, which causes
4:50:18severe facial pain. The abdessence
4:50:20nerve, also known as cranial nerve 6, is
4:50:23responsible for lateral eye movement. It
4:50:25is tested by asking the patient to move
4:50:27their eyes laterally while following an
4:50:29object. Damage can lead to crossed eyes,
4:50:32also called strabismas or double vision,
4:50:34also called dipopia. The facial nerve,
4:50:37also known as cranial nerve 7, controls
4:50:39facial expression and taste in the front
4:50:41two/irds of the tongue. It is assessed
4:50:43by asking the patient to smile, frown,
4:50:46and raise their eyebrows as well as
4:50:48identify sweet or salty tastes on the
4:50:49tip of the tongue. Disorders like Bell's
4:50:52palsy affect this nerve causing facial
4:50:54droop. The acoustic nerve, also called
4:50:57the vestibular clayar nerve and known as
4:50:59cranial nerve 8, governs hearing and
4:51:02balance. It is evaluated using the
4:51:04whisper test in Weber and Rein tests
4:51:06with a tuning fork. Damage to this nerve
4:51:09can cause vertigo, tonitis or hearing
4:51:11loss. The glossopheringial nerve also
4:51:13known as cranial nerve 9 plays a role in
4:51:16taste in the back one-third of the
4:51:18tongue and swallowing. The assessment
4:51:20involves checking the gag reflex with
4:51:22the tongue depressor and asking the
4:51:23patient to say ah while observing uvula
4:51:27movement. An absent gag reflex increases
4:51:30the risk of aspiration which means food
4:51:32or liquid entering the airway. The vagus
4:51:35nerve also known as cranial nerve 10 is
4:51:38involved in speech and swallowing. It is
4:51:41assessed by asking the patient to speak
4:51:43and swallow, checking for horarsseness
4:51:45or difficulty. Damage may lead to
4:51:47difficulty swallowing, also called
4:51:49dysphasia or voice changes. The spinal
4:51:52accessory nerve, also known as cranial
4:51:54nerve 11, controls shoulder and head
4:51:56movements. Assessment involves asking
4:51:58the patient to shrug their shoulders and
4:52:00turn their head against resistance. If
4:52:02damaged, it may cause shoulder droop or
4:52:05weakness. Finally, the hypoglossal
4:52:07nerve, also known as cranial nerve 12,
4:52:09is responsible for tongue movement. It
4:52:11is tested by asking the patient to stick
4:52:13out their tongue and move it side to
4:52:15side, as well as say light, tight,
4:52:17dynamite to assess articulation. Damage
4:52:21can result in tongue deviation to one
4:52:22side. Health care is categorized into
4:52:24different levels based on the type and
4:52:26complexity of services provided.
4:52:28Understanding these levels is essential
4:52:30for nurses as they play a crucial role
4:52:32in promoting health, preventing disease,
4:52:34and providing care across all stages of
4:52:37illness and recovery. These levels range
4:52:40from preventative measures to highly
4:52:41specialized treatments and
4:52:43rehabilitation, ensuring comprehensive
4:52:45care for individuals at different points
4:52:47in their health journey. The first
4:52:49level, preventative health care, focuses
4:52:51on educating and equipping clients to
4:52:52reduce and control risk factors for
4:52:54disease before health issues arise. This
4:52:56includes screenings such as blood
4:52:58pressure checks, cholesterol level
4:52:59monitoring, and cancer screenings like
4:53:01mammogs or colonoscopies.
4:53:04Additionally, immunizations such as flu
4:53:06shots, HPV vaccines, and tetanus shots
4:53:08help prevent infectious diseases.
4:53:11Lifestyle counseling, including stress
4:53:13management, smoking sessation programs,
4:53:15and weight management also plays a
4:53:17significant role in prevention.
4:53:19Furthermore, injuryrevention education
4:53:21such as promoting seat belt use, fall
4:53:23prevention for the elderly, and helmet
4:53:25use for cyclists is essential in
4:53:27reducing the risk of accidents. Nurses
4:53:29play a key role in patient education,
4:53:31ensuring individuals understand how to
4:53:33maintain health through lifestyle
4:53:35changes and routine checkups. Next,
4:53:37primary healthcare focuses on health
4:53:39promotion and early disease detection
4:53:41through routine medical visits and
4:53:43screenings. This includes prenatal care
4:53:45and well baby checkups as well as
4:53:47routine physical exams and vaccinations
4:53:49to prevent illness. Other examples
4:53:51include family planning and birth
4:53:53control counseling, vision and hearing
4:53:55screenings and nutrition counseling for
4:53:57managing chronic conditions like
4:53:59diabetes or hypertension. In this
4:54:01setting, nurses provide education,
4:54:03administer vaccines, and collaborate
4:54:05with healthcare providers to ensure
4:54:06early intervention and optimal patient
4:54:09outcomes. Moving forward, secondary
4:54:11health care involves the diagnosis and
4:54:13treatment of acute conditions,
4:54:14illnesses, or medical emergencies. This
4:54:17level includes emergency room visits for
4:54:19conditions such as trauma, stroke, or
4:54:22myioardial inffection. It also
4:54:24encompasses hospital admissions for
4:54:25infections like pneumonia, kidney
4:54:27infections or fractures, as well as
4:54:30diagnostic services like MRI scans, CT
4:54:32scans, and laboratory tests.
4:54:35Additionally, surgical procedures such
4:54:37as apppendecttomies, gallbladder removal
4:54:39or orthopedic surgeries fall under this
4:54:41category. Nurses in secondary healthcare
4:54:44settings play a critical role in
4:54:45assessing and stabilizing patients,
4:54:48administering medications, performing
4:54:49procedures, and coordinating care with
4:54:51the medical team to ensure efficient
4:54:53treatment and recovery. For more complex
4:54:56health conditions, tertiary health care
4:54:58provides highly specialized and advanced
4:54:59medical care. This includes intensive
4:55:02care units, ICU for ventilator dependent
4:55:04patients, oncology centers for
4:55:06chemotherapy or radiation therapy and
4:55:09burn centers for managing severe burns
4:55:11and skin grafting. Additionally,
4:55:13specialized surgical units such as
4:55:15neurosurgery and cardiac surgery
4:55:17departments cater to patients requiring
4:55:19advanced procedures. Nurses working in
4:55:21tertiary care settings require expert
4:55:22knowledge and skills to care for
4:55:24critically ill patients, manage complex
4:55:26treatments, and provide life-saving
4:55:28interventions. Finally, restorative
4:55:30health care focuses on rehabilitation
4:55:32and follow-up care to restore function
4:55:33and quality of life after illness or
4:55:35injury. This level includes home health
4:55:38care for post-surgical recovery,
4:55:40rehabilitation centers for stroke
4:55:41patients undergoing physical therapy,
4:55:43and skilled nursing facilities for wound
4:55:46care, IV therapy, and pain management.
4:55:49Additionally, inhome respit care
4:55:51provides support to caregivers of
4:55:52chronically ill patients. Nurses in
4:55:54restorative care settings are essential
4:55:55in patient education, discharge
4:55:57planning, and rehabilitation, ensuring
4:55:59long-term recovery, and improved quality
4:56:01of life. Injury prevention and emergency
4:56:04care. Carbon monoxide, CO poisoning, is
4:56:08a serious and often fatal condition
4:56:09caused by exposure to a colorless,
4:56:11odorless, and tasteless gas. CO binds to
4:56:15hemoglobin with an affinity 200 to 250
4:56:18times greater than oxygen, reducing
4:56:20oxygen transport to tissues and leading
4:56:22to hypoxia. Common sources of CO
4:56:25exposure include faulty furnaces, gas
4:56:27stoves, water heaters, fireplaces, and
4:56:30car exhaust in enclosed spaces. To
4:56:33prevent CO poisoning, it is essential to
4:56:35install carbon monoxide detectors in
4:56:36homes and regularly check their
4:56:38batteries. Additionally, ensuring proper
4:56:41ventilation when using fuel burning
4:56:42appliances and avoiding running a car
4:56:44engine in a closed garage can help
4:56:46reduce the risk of exposure. Despite
4:56:48preventive measures, CO poisoning can
4:56:50still occur with early symptoms
4:56:51including headache, dizziness, nausea,
4:56:54vomiting, and confusion. If left
4:56:56untreated, severe cases can progress to
4:56:58loss of consciousness, cherry red skin,
4:57:00seizures, and even death. Immediate
4:57:02management of CO poisoning involves
4:57:04moving the patient to fresh air and
4:57:06administering 100% oxygen via a
4:57:08non-rebreather mask. In severe cases,
4:57:12hyperbaric oxygen therapy may be
4:57:14required to rapidly remove CO from the
4:57:16bloodstream. First aid measures. In
4:57:18cases of bleeding, hemorrhage, applying
4:57:20direct pressure using sterile gauze is
4:57:22crucial to control blood loss. However,
4:57:24if an impaled object is present, it
4:57:26should not be removed. Instead, it must
4:57:28be stabilized to prevent further injury.
4:57:31For fractures, immobilization is key to
4:57:33preventing further damage. The affected
4:57:35limb should be splinted and the
4:57:36neurovvascular status should be assessed
4:57:38using the five Ps. Pain, palar, pulse,
4:57:41paristhesia, and paralysis to detect
4:57:43potential complications. Sprains, which
4:57:46involve ligament injuries, are best
4:57:47managed using the rice method. Rest the
4:57:50affected area. Apply ice for 20 minutes
4:57:52every 2 hours. Use compression with an
4:57:55elastic bandage and keep the limb
4:57:56elevated above heart level to reduce
4:57:59swelling. Frostbite requires careful
4:58:01rewarming of the affected area with
4:58:03lukewarm water at 98.6 to 108°
4:58:06Fahrenheit or 37 to 42° C as using hot
4:58:10water can cause additional tissue
4:58:11damage. A tetanus vaccine should be
4:58:14administered to prevent infection and
4:58:15rubbing the frostbitten area should be
4:58:17avoided to prevent worsening the injury.
4:58:20For burns, stopping the burning process
4:58:22is the first priority which may involve
4:58:24removing the source of the burn such as
4:58:26flames, chemicals or electricity.
4:58:28Elevating extremities helps reduce
4:58:30swelling while IV fluids should be
4:58:32administered to prevent hypoalmic shock.
4:58:34If necessary, a tetanus vaccine should
4:58:36also be given to prevent infection. The
4:58:38inflammatory response is the body's
4:58:40natural defense mechanism against injury
4:58:42or infection occurring in three distinct
4:58:44stages. The first stage known as the
4:58:47vascular response is characterized by
4:58:49athemma, redness, warmth, edema, and
4:58:52pain. These symptoms occur due to
4:58:54increased blood flow to the affected
4:58:56area which helps deliver immune cells
4:58:58and essential nutrients to begin the
4:58:59healing process. And following this, the
4:59:01second stage called the cellular
4:59:03response involves the activation of
4:59:05white blood cells chunwc's that attack
4:59:08pathogens. As a result, exodate forms
4:59:11consisting of fluid, WBC's, dead cells,
4:59:14and bacteria. This exodate can vary in
4:59:17appearance with different types
4:59:19indicating the nature of the
4:59:20inflammation. Cirrus exidate is clear
4:59:23such as the fluid found in blisters.
4:59:25Sanguinius exidate contains blood
4:59:27commonly seen in fresh wounds.
4:59:29Sarasanguinius exidate is a mix of clear
4:59:31fluid and blood while purulent exidate
4:59:33is thick yellow green and contains pus
4:59:36indicating an infection. Finally, the
4:59:39third stage known as tissue repair and
4:59:41healing begins when the damaged tissue
4:59:42is replaced by scar tissue. This stage
4:59:45restores structural integrity to the
4:59:47affected area, completing the body's
4:59:48inflammatory response and promoting
4:59:50recovery, fall prevention, seizure
4:59:53precautions, and restraint use in
4:59:54nursing. Preventing falls is a key
4:59:57priority in patient safety, especially
4:59:59for individuals at risk due to
5:00:00conditions such as orthostatic
5:00:02hypotension. To minimize the risk of
5:00:04falls, patients should be encouraged to
5:00:06sit at the side of the bed before
5:00:08standing and be instructed to change
5:00:10positions slowly to prevent dizziness or
5:00:12sudden drops in blood pressure. For
5:00:14patients who are particularly vulnerable
5:00:16to falls, additional precautions should
5:00:18be taken. These include regular
5:00:19toileting schedules to prevent rushing
5:00:21to the restroom, providing skid proof
5:00:23socks for better grip, and ensuring the
5:00:25bed is in the lowest position with
5:00:27brakes locked. Hourly rounding by health
5:00:30care staff can further reduce fall risks
5:00:32as it allows for timely assistance.
5:00:34Additionally, keeping essential items
5:00:36like the call button, water, and phone
5:00:38within reach can prevent unnecessary
5:00:41movement that could lead to falls.
5:00:43However, it is important to avoid using
5:00:45all four side rails as this can lead to
5:00:47enttrapment or increase the risk of
5:00:49injury if the patient attempts to climb
5:00:51over them. In addition to fall
5:00:53prevention, seizure precautions and
5:00:55management are crucial for patients with
5:00:56a history of seizures. Before a seizure
5:00:59occurs, preventative measures should be
5:01:01in place such as padding the bed rails
5:01:03to prevent injury and keeping suction
5:01:05and oxygen equipment at the bedside in
5:01:07case of airway compromise. During a
5:01:09seizure, immediate action should be
5:01:11taken to ensure patient safety. The
5:01:13priority is to lower the patient to the
5:01:15floor or bed and turn them to their side
5:01:17to prevent aspiration. The area should
5:01:19be cleared of any hard or sharp objects
5:01:21and any restrictive clothing should be
5:01:23loosened to avoid constriction. It is
5:01:25essential to never restrain the patient
5:01:27or put anything in their mouth as this
5:01:29can cause further harm. After the
5:01:31seizure postal phase, the nurse should
5:01:33assess vital signs and neurological
5:01:35status. Reorient the patient as they may
5:01:38be confused or drowsy and identify
5:01:40possible triggers such as missed
5:01:42medication, stress or flashing lights to
5:01:44prevent future seizures. Another
5:01:46important aspect of patient safety is
5:01:48the appropriate use of restraints.
5:01:51Restraints should always be a last
5:01:52resort and used only when necessary to
5:01:54prevent the patient from harming
5:01:56themselves or others. They can be
5:01:58classified as physical restraints such
5:01:59as vests, belts, and mittens or chemical
5:02:02restraints which include sedatives and
5:02:04antiscychotic medications. Before
5:02:07applying restraints, alternative
5:02:08strategies should be attempted first.
5:02:10These include reorientation where the
5:02:12patient is reminded of their
5:02:13surroundings, time and situation,
5:02:15supervision such as assigning a sitter
5:02:17or using video monitoring, and
5:02:20diversions like engaging the patient in
5:02:22activities such as folding towels or
5:02:23listening to music. These measures can
5:02:26help reduce agitation and promote
5:02:28patient safety without the need for
5:02:30restraints. Creating a safe and
5:02:32comfortable environment for patients is
5:02:34essential in healthcare settings. Simple
5:02:36modifications such as reducing noise,
5:02:38adjusting lighting, or positioning the
5:02:40patient near the nursing station can
5:02:41help improve their well-being and
5:02:43prevent agitation. However, in some
5:02:45situations, restraints may be necessary
5:02:47to ensure patient and staff safety, but
5:02:50they must be applied according to strict
5:02:52guidelines. In emergencies, a registered
5:02:54nurse can apply restraints immediately,
5:02:56but a provider's prescription must be
5:02:58obtained within 1 hour. The duration of
5:03:00restraint orders varies based on the
5:03:02patients age. For adults, the maximum
5:03:04duration is 4 hours. For ages 9 to 17,
5:03:07it is 2 hours. And for children under 9
5:03:10years, it is limited to 1 hour.
5:03:12Additionally, restraint orders must be
5:03:14rewritten every 24 hours, and PRN as
5:03:17needed orders are not permitted to
5:03:19ensure continuous reassessment of the
5:03:21patient's condition. Proper restraint
5:03:23placement is crucial to prevent
5:03:25complications. The padded portion should
5:03:27be applied to the wrist to protect the
5:03:29skin from injury and neurovvascular
5:03:31checks must be performed every 2 hours
5:03:33to assess circulation, movement, and
5:03:35sensation. Regular skin integrity
5:03:38assessments, frequent range of motion,
5:03:40ROM, exercises, and the use of the least
5:03:42restrictive restraint necessary help
5:03:44minimize harm. For example, mittens are
5:03:47a less restrictive option than wrist
5:03:49restraints and may be preferable when
5:03:50preventing IV removal. Additionally,
5:03:52restraints should never be too tight.
5:03:54Ensuring that two fingers can fit
5:03:56between the restraint and the patients
5:03:57limb helps prevent circulation issues.
5:04:00For safety and quick removal, a quick
5:04:02release slip knot should be used instead
5:04:04of a square knot. Restraints must be
5:04:07secured to the movable part of the bed
5:04:09frame, never to the side rails or fixed
5:04:11parts of the bed to prevent injury. When
5:04:14using belt restraints, they should
5:04:15always be placed over clothing or gowns
5:04:17to avoid direct skin damage. To
5:04:20illustrate these principles, consider
5:04:21the following situations. One, a
5:04:24confused elderly patient with dementia
5:04:26repeatedly pulls out their intravenous
5:04:28and attempts to climb out of bed. In
5:04:30this case, the first approach should be
5:04:32non-restrictive interventions such as
5:04:34reorientation, diversions, and
5:04:36supervision. If these fail, mittens may
5:04:38be a better option than wrist restraints
5:04:41since they prevent introvenous removal
5:04:43while allowing some mobility. Two, a
5:04:46patient with schizophrenia becomes
5:04:47aggressive and tries to harm staff
5:04:48members. In this situation, chemical
5:04:51restraints such as an antiscychotic or
5:04:53sedative may be considered before
5:04:55physical restraints. If physical
5:04:57restraints are necessary, they should
5:04:58only be used as a last resort and
5:05:00removed as soon as possible to avoid
5:05:02unnecessary restriction of movement.
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5:05:34the next step towards success. Fire
5:05:37safety procedures are essential in
5:05:38healthcare settings to ensure the
5:05:39protection of patients, staff, and
5:05:41facilities. The RACE protocol is a
5:05:44structured approach to fire response,
5:05:46guiding health care professionals
5:05:48through the necessary steps to manage a
5:05:49fire emergency effectively. The first
5:05:52step in race is Rescue, which involves
5:05:55moving patients to a safe location. The
5:05:57priority is horizontal evacuation,
5:06:00meaning patients should be relocated
5:06:02within the same floor if possible. If
5:06:04the situation escalates, a lateral
5:06:06evacuation to a different floor may be
5:06:08required. Next, A. Alarm emphasizes the
5:06:12importance of activating the fire alarm
5:06:13system to alert emergency responders
5:06:15promptly once the alarm is raised. C.
5:06:18Contain comes into play by closing doors
5:06:20and windows to prevent the fire from
5:06:22spreading. Additionally, any oxygen
5:06:24sources should be turned off to reduce
5:06:26fire intensity. The final step, E,
5:06:28extinguish, involves using a fire
5:06:30extinguisher to put out the fire, but
5:06:32only if it is small and safe to do so.
5:06:35When using a fire extinguisher, the PASS
5:06:37technique ensures its proper operation.
5:06:39The first step, P, pull, requires
5:06:42pulling the pin to unlock the
5:06:44extinguisher. Then, AIM directs the user
5:06:47to target the base of the fire, not the
5:06:48flames, for maximum effectiveness.
5:06:51Following this, Squeeze instructs the
5:06:53user to press the handle to release the
5:06:54extinguishing agent. Finally, S sweep
5:06:57involves moving the nozzle side to side
5:07:00until the fire is completely out.
5:07:02Understanding different bed positions
5:07:03and their uses is essential in patient
5:07:05care as each position serves a specific
5:07:08purpose in promoting comfort, recovery,
5:07:10and medical intervention. One commonly
5:07:13used position is Sims's position where
5:07:15the patient lies on their left side with
5:07:17the left hip and lower extremity
5:07:18straight while the right hip and knee
5:07:21are bent. This position is primarily
5:07:23used for enemas, rectal examinations and
5:07:25rectal medication administration. For
5:07:28instance, when a nurse needs to
5:07:29administer a suppository, placing the
5:07:32patient in Sims position ensures proper
5:07:34medication delivery. Another important
5:07:37position is the trendelenburgg position
5:07:39where the entire bed is tilted so that
5:07:41the head of the bed a b is lower than
5:07:44the foot. This position is beneficial
5:07:46for promoting venus return and is
5:07:48commonly used in cases of hypotension
5:07:50shock or postural drainage. For example,
5:07:54a patient experiencing hypoalmic shock
5:07:56may be placed in trendberg to improve
5:07:58blood flow to vital organs. Conversely,
5:08:01the reverse trendberg position involves
5:08:03tilting the bed with the foot lower than
5:08:05the head, which is particularly useful
5:08:07for promoting gastric emptying and
5:08:09preventing acid reflux. Patients with
5:08:11gastroesophageal reflux disease, gird,
5:08:14may be positioned this way to reduce
5:08:16reflux symptoms. Another variation is
5:08:18the modified trendelenberg position
5:08:20where the patient lies flat with legs
5:08:22elevated above heart level. This
5:08:24position is beneficial in cases of
5:08:26hypoalmia as it promotes venus return.
5:08:29For instance, a patient who experiences
5:08:31syncopy fainting can be placed in this
5:08:34position to restore blood flow. In cases
5:08:36where aspiration prevention and improved
5:08:38ventilation are necessary, the
5:08:39semifouers's position 15 to 45° usually
5:08:4230° is often used. A post-operative
5:08:46patient receiving tube feeds would
5:08:47benefit from this position to prevent
5:08:49aspiration. Fowler's position 45 to 60°
5:08:52is slightly more elevated and is
5:08:54commonly used during procedures like
5:08:56suctioning and to improve ventilation as
5:08:58seen in patients recovering from
5:08:59pneumonia. A further increase in
5:09:02elevation leads to high fowlers position
5:09:0460 to 90° which is crucial for patients
5:09:06with severe dispnnea or those at risk of
5:09:09aspiration during meals such as
5:09:11individuals with COPD and respiratory
5:09:13distress. When full body support is
5:09:15needed, the supine position where the
5:09:18patient lies flat on their back is
5:09:19recommended, especially for
5:09:21post-operative care and spinal surgery
5:09:23recovery. In contrast, the prone
5:09:26position where the patient lies on their
5:09:27stomach is often used to prevent hip
5:09:30flexion contraurs after lower extremity
5:09:32amputation and is particularly
5:09:34beneficial for patients with acute
5:09:36respiratory distress syndrome, ARDS.
5:09:39During the CO 19 pandemic, many patients
5:09:41in severe respiratory distress were
5:09:43placed in a prone position to improve
5:09:45oxygenation. Finally, for patients
5:09:47experiencing breathing difficulties, the
5:09:48orthopic position is highly effective.
5:09:51In this position, the patient sits on
5:09:53the side of the bed with their arms
5:09:54resting on an overbed table, which helps
5:09:57promote lung expansion. Patients with
5:09:59COPD often adopt this position to
5:10:01facilitate easier breathing. Proper bed
5:10:04positioning is essential for patient
5:10:05care as it helps prevent complications
5:10:08and promotes recovery in various medical
5:10:10conditions and procedures. For a
5:10:11mistctomy, the affected arm should be
5:10:13elevated on a pillow and the patient
5:10:15should turn only to the unaffected side
5:10:17or remain on their back. This
5:10:20positioning helps prevent lymphatic
5:10:22fluid accumulation, lympadeema, reducing
5:10:24swelling and complications. Similarly,
5:10:27for head injuries or postsurgical
5:10:29patients, a semifouler's position 30 to
5:10:3145° with the head and midline and no
5:10:34flexion is recommended. This helps
5:10:36reduce intraraanial pressure ICP and
5:10:39promotes venus drainage preventing
5:10:41further brain injury. Patients with COPD
5:10:43or respiratory distress benefit from a
5:10:45high fowlers or tripod position as this
5:10:48helps increase lung expansion and
5:10:50maximize oxygenation. When administering
5:10:53an enema, the left lateral or SIMS
5:10:55position is preferred because it
5:10:57facilitates the natural flow of the
5:10:59solution into the colon by gravity,
5:11:01ensuring effective cleansing. In the
5:11:04case of leg amputation, the affected
5:11:06limb should be elevated for the first 24
5:11:08hours to reduce swelling. But after
5:11:10that, the patient should lie prone twice
5:11:12daily for 20 to 30 minutes to prevent
5:11:15contractions. Following a thyroid
5:11:17ectomy, the patient should be in a
5:11:19semifallers's position with neck support
5:11:21while turning, which helps reduce
5:11:23swelling and prevent airway obstruction.
5:11:25For patients in shock, a modified
5:11:27trendelenberg position is used to
5:11:29improve profusion to vital organs.
5:11:31Meanwhile, during a thorosentesis, the
5:11:33patient should be seated upright and
5:11:35leaning over an overbed table, ensuring
5:11:37better access to the plural space for
5:11:39fluid removal.
5:11:41A liver biopsy requires specific
5:11:43positioning. During the procedure the
5:11:45patient lies on their left side and
5:11:47after the procedure they must be
5:11:48positioned on their right side to
5:11:51prevent post-procedure bleeding.
5:11:53Similarly for paracentesis a semifallers
5:11:55or upright position allows for an
5:11:57optimal needle insertion angle ensuring
5:12:00efficient fluid drainage. Patients
5:12:02undergoing nasogastric NG or gastrotomy
5:12:05tube GT placement should be in a high
5:12:08fowler's position during insertion and
5:12:10in a semifallers 30° position during
5:12:13feeding to prevent aspiration. After a
5:12:16laminctomy spinal surgery the patient
5:12:18must be kept straight and log rolled for
5:12:20turning to prevent spinal twisting and
5:12:22further injury. For stroke patients
5:12:24positioning depends on the type of
5:12:26stroke. In es schemic stroke, a flat
5:12:28position is recommended to optimize
5:12:30cerebral profusion. While in hemorrhagic
5:12:32stroke, the head of the bed should be
5:12:34elevated to 30 degrees to reduce
5:12:36intraanial pressure. Following a cardiac
5:12:38catheterization, the patient should
5:12:40remain on bed rest for 6 hours with the
5:12:42affected limb kept straight and the hob
5:12:44should not be elevated beyond 30° to
5:12:46prevent bleeding at the insertion site.
5:12:48Finally, for maternal patients
5:12:50experiencing dizziness due to supine
5:12:52hypotension syndrome, the left lateral
5:12:54position is advised as it prevents
5:12:56compression of the inferior venneava by
5:12:58the uterus, ensuring adequate blood flow
5:13:00to both mother and baby. Proper use of
5:13:03crutches is essential for mobility and
5:13:05preventing further injury. When
5:13:07positioning crutches, the crutch tips
5:13:08should be placed 6 in laterally and 6 in
5:13:11in front of the patient's feet to
5:13:12provide stability. Additionally, the
5:13:14crutch pads must be positioned 1.5 to 2
5:13:16in or approximately two to three finger
5:13:19widths below the axilla to prevent nerve
5:13:22damage and discomfort. To ensure proper
5:13:24support and maneuverability, the elbows
5:13:26should be slightly flexed at around 30°
5:13:28while using crutches. Different crutch
5:13:31gate patterns are used depending on the
5:13:32patients condition and mobility needs.
5:13:35The two-point gate involves moving a
5:13:36crutch and the opposite leg together,
5:13:39providing a balanced and steady motion.
5:13:41The threedup point gate requires moving
5:13:44both crutches and the affected leg
5:13:46forward together followed by moving the
5:13:48unaffected leg making it suitable for
5:13:50patients with one injured limb. In the
5:13:52four-point gate movement is more gradual
5:13:55as the patient moves one crutch then the
5:13:57opposite leg followed by the other
5:13:59crutch and the remaining leg. For
5:14:01individuals with paraplegia, the swing
5:14:03to or swing through gate is used where
5:14:06both crutches are moved forward first,
5:14:07followed by swinging the legs forward to
5:14:09meet or pass the crutches. When using
5:14:11crutches on stairs, the technique varies
5:14:13depending on whether the patient is
5:14:15ascending or descending. When going up
5:14:17the stairs, the patient should step up
5:14:19with the unaffected leg first, then move
5:14:21the affected leg and crutches up
5:14:22together. In contrast, when descending
5:14:25stairs, the process is reversed. The
5:14:27patient must move the affected leg and
5:14:29crutches down first, followed by
5:14:31stepping down with the unaffected leg.
5:14:34Using a walker correctly is essential
5:14:36for ensuring both patient safety and
5:14:38effective mobility support. When using a
5:14:40walker, the elbows should be flexed at a
5:14:4330° angle to provide stability and
5:14:45prevent strain. Additionally, when
5:14:47taking steps, it is crucial to step with
5:14:49the weaker leg first, followed by the
5:14:51stronger leg to maintain balance and
5:14:53reduce the risk of falls. One important
5:14:56safety precaution is to never pull on
5:14:58the walker to stand up. Instead, the
5:15:00patient should push up from the chair
5:15:01first before gripping the walker to
5:15:03avoid instability. For the anlex,
5:15:05understanding safe patient handling is
5:15:07key to preventing injuries for both the
5:15:08patient and the nurse. Using proper body
5:15:11mechanics is essential. This includes
5:15:13keeping the back straight, bending the
5:15:14knees rather than the waist, and
5:15:16avoiding twisting movements.
5:15:19Additionally, nurses must be familiar
5:15:20with the correct use of assistive
5:15:22devices such as crutches, canes, and
5:15:24walkers to ensure patients use them
5:15:26safely and effectively. Another critical
5:15:29aspect of patient care is knowing how to
5:15:31transfer and position patients
5:15:32correctly, such as moving them safely
5:15:34from a bed to a wheelchair and
5:15:36preventing complications like foot drop.
5:15:38Above all, safety and fall prevention
5:15:40should always be the top priority, as
5:15:42proper techniques and precautions can
5:15:44significantly reduce the risk of injury.
5:15:46Understanding the chain of infection is
5:15:48essential for infection prevention. The
5:15:50process begins with an infectious agent
5:15:52such as bacteria, viruses, fungi or
5:15:54parasites including stafylocus orius and
5:15:58the influenza virus. These pathogens
5:16:00reside in a reservoir which may be the
5:16:02human body, soil, water or contaminated
5:16:04surfaces. The portal of exit refers to
5:16:07how the pathogen leaves the host such as
5:16:09through blood, respiratory droplets,
5:16:11feces or skin wounds. The infection then
5:16:13spreads via a mode of transmission,
5:16:15including contact, droplet, or airborne
5:16:17roots, such as hand-to-hand contact,
5:16:20coughing, or contaminated surfaces.
5:16:22Next, the pathogen enters a new host
5:16:25through a portal of entry, which may
5:16:27include breaks in the skin, inhalation,
5:16:29or mucous membranes. Finally, a
5:16:32susceptible host becomes infected,
5:16:34particularly those at higher risk, such
5:16:36as immunocmpromised individuals, the
5:16:39elderly, infants, and people with
5:16:40chronic diseases. Several risk factors
5:16:43increase susceptibility to infection. A
5:16:45weakened immune system due to
5:16:47chemotherapy or organ transplants
5:16:49significantly raises the risk. Chronic
5:16:52and acute diseases such as diabetes.
5:16:54Chronic obstructive pulmonary disease,
5:16:56cancer, and autoimmune disorders further
5:16:58contribute to vulnerability. Poor
5:17:00personal hygiene and hand hygiene.
5:17:01Crowded living conditions such as in
5:17:03nursing homes, prisons, and dormitories.
5:17:05Introvenous drug use, unprotected sex,
5:17:08and poor sanitation, including
5:17:09contaminated water and improper waste
5:17:11disposal, also increase infection risk.
5:17:15Infections progress through four
5:17:16distinct stages. The incubation period
5:17:18is the time between exposure and the
5:17:20first appearance of symptoms, which
5:17:22varies depending on the infection. For
5:17:25example, chickenpox has an incubation
5:17:27period of 10 to 21 days. During the
5:17:28prodal stage, non-specific symptoms such
5:17:31as mild fever, fatigue, and malaise
5:17:33appear, making this the most infectious
5:17:35stage. The illness stage follows where
5:17:38disease specific symptoms become evident
5:17:40such as a rash in measles or a severe
5:17:43cough in pneumonia. Finally, the
5:17:46convolescent stage marks the recovery
5:17:47phase during which symptoms gradually
5:17:50resolve.
5:17:51To prevent the spread of infections,
5:17:53infection control measures must be
5:17:54followed. Standard precautions
5:17:56applicable to all patients include hand
5:17:58hygiene before and after patient
5:18:00contact, wearing gloves when contact
5:18:02with body fluids is expected, and
5:18:04ensuring the proper disposal of sharps
5:18:06and biohazard materials. In cases
5:18:08requiring additional protection,
5:18:10transmissionbased precautions are
5:18:11necessary. For airborne infections such
5:18:14as measles, vicella, and tuberculosis,
5:18:17patients should be placed in a private
5:18:18room with negative pressure, and health
5:18:21care providers must wear an N95
5:18:23respirator mask along with gloves,
5:18:26gowns, and eye protection as needed.
5:18:28Droplet precautions required for
5:18:30infections like influenza, menitis,
5:18:32reubella, pertasus, mumps, and dtheria
5:18:36involve private rooms or cohorting with
5:18:38the same infection and require masks
5:18:40within 3 ft of the patient. Contact
5:18:42precautions used for infections such as
5:18:45methasylan resistant stylocus orius
5:18:47vancomyin resistant entrocus clustradi
5:18:50difficil. Wound infections and
5:18:52respiratory sensitial virus include
5:18:55wearing gloves and gowns preferring a
5:18:58private room and performing hand hygiene
5:19:00with soap and water for clustil
5:19:03infections. Maintaining a sterile field
5:19:05is essential to prevent contamination
5:19:07during medical procedures. To uphold
5:19:09sterility, it is crucial to avoid
5:19:11coughing, sneezing, or talking over the
5:19:13sterile field as airborne contaminants
5:19:16can compromise its integrity.
5:19:18Additionally, the outer 1-in edge of the
5:19:20sterile field is not sterile. So, any
5:19:22item that touches this area must be
5:19:24discarded. Furthermore, objects held
5:19:26below the waist or above the chest are
5:19:28considered contaminated and should not
5:19:30be used. To maintain sterility while
5:19:32adding objects, they must be dropped
5:19:34onto the field from at least 6 in above
5:19:36to prevent accidental contamination.
5:19:38Additionally, health care professionals
5:19:40must never turn their back on a sterile
5:19:42field or reach across it as doing so
5:19:45increases the risk of introducing
5:19:46contaminants. Lastly, any sterile item
5:19:49that comes into contact with moisture is
5:19:51considered nonsterile as moisture can
5:19:54carry microorganisms onto the field.
5:19:56Success in the ENCLEX isn't about luck,
5:19:58it's about preparation. Before we move
5:20:00on, I want to invite you to enroll in
5:20:01our ANCLEX review crash course and take
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5:20:24success. Sign up today and make your
5:20:27NALEX dream a reality. When performing a
5:20:30physical assessment, four key techniques
5:20:31are used. The first is inspection, which
5:20:33relies on site to assess the size,
5:20:35shape, color, and symmetry of body
5:20:37structures. Next is palpation, which
5:20:40involves using touch to evaluate
5:20:41temperature, texture, and tenderness.
5:20:43The dorsal surface of the hand is best
5:20:45for assessing temperature, while the
5:20:47palmer surface is ideal for detecting
5:20:48vibrations. The third technique,
5:20:51percussion, involves tapping body parts
5:20:53to assess size, tenderness, and density
5:20:56of underlying structures. The final
5:20:58technique is oscultation which requires
5:21:00listening to body sounds such as those
5:21:02from the heart, lungs, and bowels.
5:21:04Typically, assessments follow the order
5:21:06of inspection. Palpation, percussion,
5:21:08oscultation, except in abdominal
5:21:10assessments where the order changes to
5:21:12inspection, oscultation, percussion,
5:21:15palpation to prevent disrupting bowel
5:21:17sounds. For an eye assessment, several
5:21:19key evaluations help determine eye
5:21:21function and alignment. The extraocular
5:21:23muscles include the inferior and
5:21:25superior oblique, lateral, medial,
5:21:27inferior, and superior rectus muscles,
5:21:30which control eye movement. The corial
5:21:33light reflex test involves shining a
5:21:34light at the patient's eyes to check for
5:21:36a symmetrical reflection on the corneas,
5:21:39indicating proper alignment. Another
5:21:41important test is the cover and uncover
5:21:43test, which detects strabismas by
5:21:45observing for movement when one eye is
5:21:47uncovered. Additionally, the six
5:21:49cardinal gaze positions test eye muscle
5:21:51function by having the patient follow a
5:21:53finger in an H pattern. Lastly, the PE r
5:21:57acronym is used to assess pupil
5:21:59function. Pupils should be clear, equal
5:22:01in size, round, reactive to light, and
5:22:04able to accommodate to near and far
5:22:05objects. Ear assessment and blood
5:22:08pressure measurement. Proper ear
5:22:09assessment is essential for identifying
5:22:11any abnormalities and ensuring accurate
5:22:13diagnosis. When evaluating ear
5:22:15alignment, the oracles should be level
5:22:18with the inner canthus of the eyes to
5:22:20indicate normal positioning. When using
5:22:22an otoscope, technique varies based on
5:22:24the patients age. For adults, the oracle
5:22:27should be pulled up and back, whereas
5:22:29for children under 3 years old, the
5:22:31oracle should be pulled down and back to
5:22:32straighten the ear canal. The otoscope
5:22:34should be inserted 1 to 1.5 cm into the
5:22:37canal without touching the walls to
5:22:39prevent discomfort and injury. Equally
5:22:42important is the proper measurement of
5:22:44blood pressure, which includes assessing
5:22:46pulse pressure, the difference between
5:22:47systolic and diastolic blood pressure. A
5:22:50normal pulse pressure ranges from 30 to
5:22:5250 mm of mercury. A widened pulse
5:22:56pressure greater than 50 mm of mercury
5:22:58may indicate conditions such as
5:23:00hypertension, aortic regurgitation, or
5:23:02increased intraanial pressure. In
5:23:05contrast, a narrow pulse pressure less
5:23:06than 30 mm of mercury could be a sign of
5:23:09hypoalmic shock, heart failure, or
5:23:11cardiac tampenide, all of which require
5:23:14immediate medical attention.
5:23:16Accurate BP measurement also depends on
5:23:18using the correct cuff size. The cuff
5:23:20width should be 40% of the arm
5:23:22circumference, while the bladder length
5:23:24should cover 80% of the arm. Using an
5:23:27incorrect cuff size can lead to
5:23:28inaccurate readings. A cuff that is too
5:23:31large results in a falsely low BP while
5:23:34a cuff that is too small leads to a
5:23:35falsely high BP. Additionally, BP should
5:23:39not be measured on an arm with an IV
5:23:41infusion running a history of mastctomy
5:23:44on that side or an AV fistula used for
5:23:46diialysis as this can cause
5:23:48complications. To estimate systolic
5:23:51blood pressure using palpation, follow
5:23:53these steps. One, palpate the radial
5:23:56pulse. Two, inflate the cuff until the
5:23:59pulse disappears. Three, add 30 mm of
5:24:02mercury more for accuracy. Four, slowly
5:24:05release the pressure and note when the
5:24:07pulse returns. Lastly, proper patient
5:24:09positioning is crucial for an accurate
5:24:11BP reading. The patient should be seated
5:24:13with feet flat on the floor and legs
5:24:15uncrossed to prevent any false
5:24:17variations in blood pressure readings.
5:24:18So, blood pressure classification is
5:24:20essential in assessing cardiovascular
5:24:22health and guiding appropriate
5:24:23interventions. Blood pressure is
5:24:26measured using two values. Systolic
5:24:27blood pressure which represents the
5:24:29pressure in the arteries when the heart
5:24:31contracts and diastolic blood pressure
5:24:34which indicates the pressure when the
5:24:35heart relaxes between beats. A normal
5:24:38blood pressure reading is less than 120
5:24:40mm of mercury for systolic and less than
5:24:4380 mm of mercury for diastolic. When
5:24:46blood pressure starts to rise but has
5:24:48not yet reached hypertensive levels, it
5:24:50falls into the prehypertension category
5:24:52with systolic readings between 120 and
5:24:55139 mm of mercury and diastolic readings
5:24:58between 80 and 89 mm of mercury. This
5:25:02stage signals an increased risk for
5:25:04hypertension, making lifestyle
5:25:05modifications crucial. If blood pressure
5:25:08continues to rise, it is classified as
5:25:10stage 1 hypertension where systolic
5:25:13pressure ranges from 140 to 159 millm of
5:25:17mercury and diastolic pressure from 90
5:25:19to 99 mm of mercury. This stage often
5:25:23requires medical intervention in
5:25:24addition to lifestyle changes. More
5:25:26severe elevation leads to stage 2
5:25:29hypertension defined by a systolic
5:25:31pressure of 160 mm of mercury or higher
5:25:35and a diastolic pressure of 100 mm of
5:25:37mercury or higher requiring more
5:25:39intensive treatment to prevent
5:25:41complications such as stroke or heart
5:25:43disease. On the other hand, hypotension
5:25:46occurs when systolic pressure falls
5:25:48below 90 millm of mercury which can lead
5:25:50to inadequate blood flow to organs
5:25:52causing dizziness, fainting or shock in
5:25:54severe cases. Recognizing these
5:25:56classifications helps health care
5:25:58professionals manage blood pressure
5:25:59effectively and reduce the risk of
5:26:01serious cardiovascular conditions.
5:26:03Pulses and nasogastric tube care.
5:26:05Assessing pulses is a fundamental part
5:26:07of patient evaluation providing critical
5:26:09insights into cardiovascular function. A
5:26:11normal pulse rate varies by age with
5:26:13adults typically ranging from 60 to 100
5:26:16beats per minute while infants have a
5:26:18faster rate of 120 to 160 beats per
5:26:21minute. When performing a pulse
5:26:23assessment, it is essential to evaluate
5:26:25rate to identify normal rhythm,
5:26:26bredicardia or tacic cardia. Rhythm
5:26:29determining if it is regular or
5:26:31irregular and equality comparing pulses
5:26:34on both sides of the body for
5:26:35consistency. Additionally, the pulse
5:26:38strength scale is used to classify pulse
5:26:40intensity. A pulse rate of zero is
5:26:42absent, 1 plus is weak or diminished, 2
5:26:44plus is normal, 3 plus is strong, and
5:26:47four plus is bounding, which may
5:26:49indicate conditions such as hypertension
5:26:51or fluid overload. Different methods of
5:26:53pulse measurement include the radial and
5:26:55apical pulses. The radial pulse located
5:26:58on the thumb side of the wrist should be
5:26:59counted for 30 seconds and multiplied by
5:27:01two if regular, but for a full minute if
5:27:04irregular. In contrast, the apical pulse
5:27:07found at the fifth intercostal space at
5:27:09the left mid-clavicular line must always
5:27:11be counted for a full minute if
5:27:13irregular or if the patient is on
5:27:14cardiac medications. A crucial concept
5:27:17in pulse assessment is the pulse deficit
5:27:19which is calculated by subtracting the
5:27:21radial pulse from the aical pulse. A
5:27:24difference greater than two beats may
5:27:26indicate atrial fibrillation, heart
5:27:28failure or an arhythmia requiring
5:27:30further evaluation. Shifting focus to
5:27:33nasogastric tube care. Proper technique
5:27:35and precautions are essential for
5:27:36patient safety. During insertion, the
5:27:39patient should be placed in a high
5:27:40fowler's position to reduce the risk of
5:27:43aspiration. Clear patient communication
5:27:45is necessary and a signal system should
5:27:47be established so the patient can
5:27:48indicate discomfort. Before insertion, a
5:27:51towel should be placed across the chest
5:27:53to prevent messes and a water-based
5:27:55lubricant should be used to facilitate
5:27:56smooth passage. As the tube is inserted,
5:27:59the patient should be encouraged to sip
5:28:00water, aiding the tube's passage into
5:28:03the esophagus. If gagging or choking
5:28:05occurs, the insertion should be paused
5:28:07slightly to allow recovery before
5:28:09proceeding. Proper placement
5:28:10confirmation is critical. The gastric pH
5:28:13should be checked and an X-ray should be
5:28:15obtained before the first feeding.
5:28:17Additionally, prefeeding checks involve
5:28:19verifying the presence of bowel sounds
5:28:21and reassessing gastric content, pH, to
5:28:24ensure safe administration of nutrition
5:28:25or medications.
5:28:27Thank you for watching this lecture. I
5:28:30appreciate your time and dedication to
5:28:32learning. I hope this session helped
5:28:34deepen your understanding of the topic.
5:28:37Before we move ahead, let me take a
5:28:38quick moment to tell you something that
5:28:40could completely change your enclelex
5:28:42journey. If you're serious about passing
5:28:44the ENCLEX in just one week or even
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5:28:50our complete online enclelex crash
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5:29:32also get 500 nextgen casebased questions
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5:30:02enroll now. Link is given in description
5:30:04box. Let's continue the video. Are you
5:30:06struggling with enclelex
5:30:07pharmarmacology? We've got you covered.
5:30:09Enclelex loves to test you on meds and
5:30:11we've compiled all the must know drugs
5:30:12in this short review. Watch till the end
5:30:14and you won't need to waste hours
5:30:16reading. This is everything you need to
5:30:17pass. Let's dive in. Warerin couadin is
5:30:20an oral anti-coagulant that works by
5:30:22inhibiting vitamin K dependent clotting
5:30:24factors 2 7 9 and 10 as well as proteins
5:30:28C and S by reducing the blood's ability
5:30:30to clot. It helps prevent the formation
5:30:32of new clots. However, it does not
5:30:35dissolve existing ones. Due to its
5:30:37anti-coagulant properties, Warferin is
5:30:40commonly prescribed for conditions that
5:30:42increase the risk of blood clots. For
5:30:44instance, in patients with atrial
5:30:45fibrillation, it helps prevent stroke by
5:30:47reducing clot formation. Similarly,
5:30:50those with mechanical or artificial
5:30:51heart valves require warfin to prevent
5:30:54embolism. Individuals with a history of
5:30:56deep vein thrombosis, DVT, or pulmonary
5:30:59embolism, PE, are also prescribed this
5:31:01medication to prevent recurrence.
5:31:04Additionally, Warin is used as a
5:31:05post-surgical prophylaxis particularly
5:31:08after orthopedic surgeries to minimize
5:31:10the risk of clot formation. Moreover,
5:31:13patients with hypercoagulable disorders
5:31:15such as factor fyliden or protein CS
5:31:17deficiency benefit from warfarin therapy
5:31:20to regulate excessive clotting
5:31:21tendencies. Since warfarin has a narrow
5:31:24therapeutic range, careful monitoring is
5:31:26essential to ensure safety and efficacy.
5:31:29This is done through international
5:31:30normalized ratio testing which measures
5:31:32how long it takes for blood to clot. The
5:31:35target INR range depends on the
5:31:37condition being treated. For most
5:31:39conditions including DVT, PE and atrial
5:31:41fibrillation, the recommended INR range
5:31:44is 2.0 to 3.0. In patients with
5:31:48mechanical heart valves, a slightly
5:31:50higher range of 3.0 to 3.5 is required
5:31:53to prevent clot formation. Because
5:31:56several factors can influence INR
5:31:58levels, frequent monitoring is
5:32:00especially important after dosage
5:32:02changes, starting new medications, or
5:32:04significant dietary adjustments. In
5:32:06cases where warerin levels become too
5:32:08high leading to an increased risk of
5:32:10bleeding, an antidote is necessary to
5:32:12reverse its effects. The primary
5:32:14antidote is vitamin K phytononadone
5:32:17which helps restore clotting function.
5:32:19However, in severe bleeding cases, fresh
5:32:22frozen plasma FFP, Prothroin complex
5:32:25concentrate PCC or activated recombinant
5:32:28factor 7 may be required for more rapid
5:32:30reversal. Since warin's effectiveness is
5:32:33closely tied to vitamin K levels,
5:32:35dietary consistency is crucial.
5:32:37Consuming too much vitamin K can reduce
5:32:39warferin's effect while too little can
5:32:42increase the risk of excessive
5:32:43anticoagulation. Therefore, patients
5:32:45should maintain a steady intake of
5:32:46vitamin K-rich foods rather than
5:32:49eliminating them completely. Some foods
5:32:51high in vitamin K that require
5:32:52monitoring include leafy greens such as
5:32:54spinach, kale, broccoli, Brussels
5:32:56sprouts, cabbage, liver, and green tea.
5:32:59Additionally, certain beverages like
5:33:00cranberry juice, grapefruit juice, and
5:33:02alcohol can increase INR levels, thereby
5:33:05heightening the risk of bleeding. Warin
5:33:07interacts with various medications and
5:33:09substances, some of which increase
5:33:10bleeding risk, while others reduce its
5:33:13efficacy. A patients should avoid or use
5:33:16caution with the following NSAs,
5:33:18ibuprofen, neproxin, and aspirin, which
5:33:21can significantly increase bleeding
5:33:23risk. Alcohol, which can enhance
5:33:25Warfin's anti-coagulant effects.
5:33:27Antibiotics such as cyproloxicin,
5:33:30aithramycin, metroniditool, sulanomides
5:33:34which may alter INR levels. Herbal
5:33:36supplements such as garlic, jinseng,
5:33:38ginko, ginger, St. John's wart, turmeric
5:33:42which can either enhance or reduce
5:33:43warerin's effects and other
5:33:45anticoagulants which can further
5:33:46increase bleeding risk when combined.
5:33:49Despite its benefits, warerin is not
5:33:51suitable for all patients. It is
5:33:52strictly contraindicated in pregnancy
5:33:54due to its territogenic effects category
5:33:56X which can lead to fetal warerin
5:33:59syndrome cranioacial abnormalities and
5:34:01and skeletal defects. Instead, pregnant
5:34:04patients requiring anti-coagulation are
5:34:06typically prescribed Hepin or inoxipern.
5:34:09Warferin is also contraindicated in
5:34:11patients with active bleeding disorders
5:34:13or recent hemorrhage, severe liver or
5:34:15kidney disease which affects its
5:34:16metabolism and clearance, uncontrolled
5:34:18hypertension as it increases the risk of
5:34:20bleeding and recent major surgery or
5:34:23trauma where the risk of excessive
5:34:24bleeding is high. To maximize warn's
5:34:28effectiveness and minimize risks,
5:34:29patients must follow strict adherence
5:34:31guidelines. Take the medication at the
5:34:33same time daily, usually in the evening.
5:34:35Do not stop warfering abruptly without
5:34:37consulting a health care provider as
5:34:39this can lead to clot formation. Avoid
5:34:41activities that pose a high risk of
5:34:42bleeding such as contact sports. Use a
5:34:45soft bristle toothbrush and an electric
5:34:47razor to reduce the risk of bleeding
5:34:48from minor cuts. Additionally, patients
5:34:51should report any signs of abnormal
5:34:53bleeding immediately, including unusual
5:34:55bruising, black terry stools, molina,
5:34:57hematia, blood and urine, excessive
5:35:00bleeding from minor cuts, bleeding gums,
5:35:02epistaxis, nose bleeds, and sudden
5:35:05severe headache, which may indicate
5:35:07brain hemorrhage. If a patient is
5:35:09prescribed antibiotics, they should
5:35:10notify their health care provider
5:35:12promptly as antibiotics can cause INR
5:35:14fluctuations requiring dosage
5:35:16adjustments. The length of time a
5:35:18patient must take warpherin depends on
5:35:20their underlying condition for DVT or
5:35:22PE. Therapy usually lasts 3 to 6 months
5:35:25but may be extended for recurrent cases.
5:35:27In atrial fibrillation, warerin is
5:35:30typically taken lifelong to prevent
5:35:31stroke. For patients with mechanical
5:35:33heart valves, lifelong therapy is
5:35:35required following major surgery.
5:35:37Warerin is used temporarily depending on
5:35:39the individual's clotting risk. Now
5:35:42let's discuss the heperin. Heperin is a
5:35:44fast acting anti-coagulant that works by
5:35:46enhancing the activity of anti-throbin 3
5:35:49which inactivates thrombin and factor
5:35:5110A. This prevents clot formation though
5:35:55it does not dissolve existing clots.
5:35:58Unlike warfarerin heperin is
5:36:00administered parentally either through
5:36:02intravenous infusion for rapid
5:36:03anti-coagulation or subcutaneous
5:36:06injection for clot prevention since it
5:36:08is not absorbed orally. Heperin plays a
5:36:11crucial role in the treatment and
5:36:12prevention of various thrombomolic
5:36:14disorders including deep vein thrombosis
5:36:17DVT and pulmonary embolism PE. It is
5:36:21commonly used in acute coronary
5:36:22syndromes ACS such as myocardial
5:36:25infarction and in atrial fibrillation to
5:36:28reduce the risk of clot related stroke.
5:36:30Additionally, it is indicated for
5:36:32conditions like disseminated
5:36:33intravascular coagulation, DIC,
5:36:36postsurgical prophylaxis in orthopedic
5:36:39surgeries and prolonged immobility as
5:36:41well as during hemodialysis and extra
5:36:44corporeal circulation procedures such as
5:36:45in heart lung machines. When rapid
5:36:48anticoagulation is required, intravenous
5:36:50heperin is preferred. While subcutaneous
5:36:52administration is commonly used for DVT
5:36:55prevention, especially in immobile
5:36:56patients since heperin has a narrow
5:36:58therapeutic range. Regular monitoring of
5:37:01the activated partial thromboplastin
5:37:02time uh PTT is essential. The
5:37:05therapeutic apt range is typically 1.5
5:37:08to 2.5 times the normal value normal 25
5:37:12to 35 seconds. Therapeutic 46 to 70
5:37:16seconds. For patients receiving
5:37:18intravenous heperin a PTT should be
5:37:20checked every 6 hours and dose
5:37:22adjustments should be made accordingly
5:37:24to maintain safe and effective
5:37:25anti-coagulation.
5:37:27In cases of excessive anti-coagulation
5:37:29or severe bleeding due to heperin,
5:37:31proteamine sulfate serves as the
5:37:33antidote, effectively reversing its
5:37:35effects. This intervention is
5:37:37particularly critical in emergencies
5:37:39involving heperin overdose. A more
5:37:41predictable alternative to standard
5:37:42heperin is low molecular weightpin LMW
5:37:46such as enoxapin.
5:37:48LMW has several advantages including a
5:37:50longer half-life, more stable
5:37:52anti-coagulation, and the convenience of
5:37:54not requiring frequent APTT monitoring.
5:37:57It is commonly used for DVT and PE
5:37:59prophylaxis and is preferred over
5:38:01warfare during pregnancy due to its
5:38:02safer profile. Administered as a
5:38:05subcutaneous injection, usually in the
5:38:07abdomen, LMW provides a more convenient
5:38:09anti-coagulation option for many
5:38:11patients. The most common adverse effect
5:38:14of heperin therapy is bleeding which can
5:38:16manifest as bruising, hematia, black
5:38:18terry stools, nose bleeds or excessive
5:38:21bleeding from minor cuts. A serious but
5:38:24less common complication is heperin
5:38:25induced thrombocytoenia hijit.
5:38:29An immune mediated reaction that leads
5:38:31to a dangerous drop in platelet count
5:38:33and paradoxical clotting. Regular
5:38:35platelet count monitoring is essential
5:38:37and if hit occurs, heperin must be
5:38:39discontinued immediately and replaced
5:38:41with a non- heperin anti-coagulant such
5:38:43as argotropin. Other potential
5:38:45complications include osteoporosis with
5:38:47long-term use and hypersensitivity
5:38:50reactions such as fever, chills or
5:38:52urtdicaria. Heperin should not be used
5:38:54in patients with active bleeding
5:38:56disorders such as hemorrhagic stroke,
5:38:58gastrointestinal bleeding or peptic
5:39:00ulcers. It is also contraindicated in
5:39:02severe thrombocytoenia particularly in
5:39:05cases of HIT and in uncontrolled
5:39:07hypertension due to the increased risk
5:39:09of brain hemorrhage. Additionally,
5:39:11patients who have recently undergone
5:39:13major surgery or trauma should avoid
5:39:15hepin due to the heightened risk of
5:39:17bleeding. Special caution is required in
5:39:19those receiving spinal or epidural
5:39:21anesthesia as heperin use in such cases
5:39:24can lead to spinal hematoma potentially
5:39:26resulting in paralysis. Certain
5:39:29medications can increase the risk of
5:39:30bleeding when taken alongside heperin
5:39:32including Nsaides, ibuprofen, neproxin,
5:39:35aspirin, and other anti-coagulants.
5:39:37Therefore, concurrent use should be
5:39:39avoided unless specifically indicated by
5:39:42a health care provider. For patients,
5:39:44self-administering subcutaneous hepin
5:39:47proper technique is crucial. Injection
5:39:49sites should be rotated with the abdomen
5:39:52at least 2 in from the umbilicus being
5:39:54the preferred area. Massaging the
5:39:56injection site should be avoided as it
5:39:58can cause bruising. To minimize bleeding
5:40:01risks, patients should use a soft
5:40:02bristle toothbrush and an electric razor
5:40:05instead of a traditional blade.
5:40:07Additionally, they should be vigilant
5:40:08for signs of excessive bleeding,
5:40:10including unusual bruising, blood in the
5:40:12stool or urine or persistent bleeding
5:40:14from minor cuts. Any sudden decrease in
5:40:16platelet count or signs of hit such as
5:40:18new clot formation or severe bruising
5:40:20should be reported immediately. Now,
5:40:23let's talk about ACE inhibitors. ACE
5:40:24inhibitors recognized by their dashpril
5:40:26suffix such as linopril and alipril
5:40:29captopril ramipril are widely used in
5:40:32the management of cardiovascular
5:40:33conditions. Their primary mechanism of
5:40:35action involves blocking the conversion
5:40:37of angotensin I to angotensin 2 a potent
5:40:40vasoc constrictor. As a result blood
5:40:43vessels relax leading to vasoddilation
5:40:45and a subsequent reduction in blood
5:40:47pressure. Additionally, these drugs
5:40:49decrease aldoststerone secretion, which
5:40:51means less sodium and water retention
5:40:54while increasing potassium retention.
5:40:56Due to their effects, ACCE inhibitors
5:40:59are commonly prescribed for several
5:41:01conditions. They serve as a firstline
5:41:03treatment for hypertension by
5:41:04effectively lowering blood pressure. In
5:41:07heart failure, they help by reducing the
5:41:09workload on the heart through decreased
5:41:11afterload following a moardial
5:41:13infarction. They play a crucial role in
5:41:15preventing heart remodeling.
5:41:17Furthermore, in diabetic neuropathy, ACE
5:41:19inhibitors slow the progression of
5:41:21kidney damage, offering renal
5:41:22protection. However, in patients with
5:41:24chronic kidney disease, they must be
5:41:26used cautiously as they can be both
5:41:28protective and potentially harmful
5:41:30depending on the stage of kidney
5:41:32dysfunction. When administering ACE
5:41:34inhibitors, several nursing
5:41:35considerations must be kept in mind.
5:41:38Blood pressure should always be checked
5:41:39beforehand and the medication should be
5:41:41withheld if the systolic BP is below 90
5:41:44mm of mercury. Since these drugs
5:41:47increase potassium levels, regular
5:41:48monitoring is essential to prevent
5:41:50hypercalemia.
5:41:52Additionally, kidney function should be
5:41:53assessed by checking creatinine and bun
5:41:55levels as ACE inhibitors may cause renal
5:41:58impairment. One of the most common
5:42:00complaints among patients is a
5:42:02persistent dry cough which if
5:42:04intolerable may necessitate
5:42:06discontinuation. Moreover, patients
5:42:08should be monitored for orthostatic
5:42:10hypotension and educated to change
5:42:12positions slowly to prevent dizziness
5:42:14and falls.
5:42:16A particularly serious adverse effect to
5:42:18watch for is angioadema which manifests
5:42:20as swelling of the face, lips, tongue or
5:42:24throat. This is a life-threatening
5:42:26reaction requiring immediate
5:42:27discontinuation and emergency care.
5:42:30Additionally, ACE inhibitors are
5:42:31strictly contraindicated in pregnancy
5:42:33due to their potential to cause fetal
5:42:35harm. Patients should also be advised to
5:42:37avoid potassium richch foods such as
5:42:38bananas, oranges, spinach, and potatoes
5:42:42to prevent excessive potassium
5:42:43accumulation. While ACE inhibitors offer
5:42:46significant benefits, they also come
5:42:48with potential side effects. The most
5:42:50common include dry cough, dizziness, and
5:42:52hypotension. More severe adverse effects
5:42:54include angioadeema, hypercalemia, which
5:42:57increases the risk of cardiac
5:42:59arhythmias, acute kidney injury
5:43:01requiring close renal function
5:43:02monitoring, and reflex tacocardia, a
5:43:05temporary heart rate increase due to
5:43:06lowered blood pressure. Due to these
5:43:09risks, ACE inhibitors are
5:43:10contraindicated in specific conditions.
5:43:13They should not be used during pregnancy
5:43:14in individuals with a history of
5:43:16angioadeema or in patients with severe
5:43:18kidney disease as they can further
5:43:20impair renal function. Moreover, in
5:43:22those with bilateral renal artery
5:43:24stenosis, ACE inhibitors can lead to
5:43:26kidney failure. For patients who cannot
5:43:28tolerate ACE inhibitors, particularly
5:43:30those experiencing a persistent cough or
5:43:32angioadema, an alternative option is
5:43:35ARBs, angotensin 2 receptor blockers.
5:43:38These medications such as Loartin and
5:43:40Valartin work similarly but do not cause
5:43:42the dry cough associated with ACE
5:43:44inhibitors. From an EN anklex
5:43:46perspective, there are several key
5:43:48points to remember. If a patient reports
5:43:50swelling of the lips, tongue or throat,
5:43:52the medication must be stopped
5:43:54immediately and emergency assistance
5:43:56should be sought. Blood pressure and
5:43:58potassium levels should always be
5:43:59checked before administration and
5:44:01potassium supplements or potassium
5:44:03sparing diuretics like spironolactone
5:44:05should be avoided to prevent
5:44:07hypercalemia. Additionally, patients
5:44:09should be instructed to rise slowly to
5:44:11prevent falls due to orthostatic
5:44:13hypotension. Lastly, the use of NSAIDES
5:44:16such as ibuprofen and neproxin should be
5:44:18avoided as these drugs can reduce the
5:44:20effectiveness of ACE inhibitors and
5:44:22worsen kidney function. Let's discuss CC
5:44:26CB calcium channel blockers. CCBS play a
5:44:30crucial role in cardiovascular
5:44:31management by blocking calcium from
5:44:33entering cardiac and smooth muscle
5:44:35cells. This action leads to
5:44:37vasoddilation a decreased heart rate and
5:44:39reduced myioardial contractility
5:44:42ultimately easing the workload on the
5:44:43heart. In simpler terms CCBs act like
5:44:46valium for the heart promoting
5:44:48relaxation and reducing strain. Due to
5:44:51these effects, they are primarily used
5:44:53for hypertension as they lower blood
5:44:54pressure, angina by reducing cardiac
5:44:57workload, atrial fibrillation and atrial
5:44:59flutter to control heart rate and super
5:45:02ventricular tacocardia SVT. Recognizing
5:45:06CCBs by their drug name patterns can aid
5:45:08in quick identification. Many of these
5:45:10medications end in - such as dilism or
5:45:13dash in like amloopine, nifetapine and
5:45:17verupil. These drugs are further
5:45:19classified into two main types.
5:45:21Dihydroparidines DHPs and non
5:45:24dihydroparidines non-dps.
5:45:27Dihydroparadines primarily target
5:45:29vascular smooth muscle making them
5:45:30highly effective for hypertension and
5:45:32angina. Examples include amloopine,
5:45:35nifetapine and felatopine which work by
5:45:38causing potent vasoddilation with
5:45:39minimal effects on heart rate. However,
5:45:42they may lead to adverse effects such as
5:45:44reflex tacocardia, peripheral edema and
5:45:46dizziness. On the other hand, non
5:45:48dihydropiritines such as dilioazm and
5:45:51verapamil act on both the heart and
5:45:53blood vessels. These are best suited for
5:45:55conditions like atrial fibrillation,
5:45:57angina and hypertension as they slow the
5:46:00heart rate, reduce contractility and
5:46:02provide mild vasoddilation. Uh despite
5:46:05their benefits, they can cause
5:46:07braticardia, heart block and
5:46:09constipation with verapamil being
5:46:11particularly associated with severe
5:46:13constipation. When administering CCBs,
5:46:16several key nursing considerations must
5:46:18be kept in mind. First, blood pressure
5:46:20should always be monitored before
5:46:21administration and the medication should
5:46:23be held if systolic BP falls below 100
5:46:26mm of mercury. Similarly, heart rate
5:46:29should be assessed as CCBs, particularly
5:46:31non DHPS should be used with caution if
5:46:34HR drops below 60 beats per minute.
5:46:38Additionally, patients should be advised
5:46:39to avoid grapefruit juice as it can
5:46:41increase drug levels and lead to
5:46:42toxicity. Abrupt discontinuation of CCBs
5:46:46should also be avoided to prevent
5:46:48rebound hypertension. Moreover, patients
5:46:51with hypertension should steer clear of
5:46:53over-the-counter OTC cold medications
5:46:55containing decongestants like
5:46:57pseudoeepadrine which can cause vasoc
5:47:00constriction and worsen hypertension.
5:47:02Given that dizziness is a major side
5:47:04effect due to hypotension, fall risk
5:47:06precautions are essential and patients
5:47:08should be instructed to change positions
5:47:09slowly. Common side effects of CCBs
5:47:12include dizziness, headache, flushing
5:47:15and peripheral edema. While severe
5:47:17reactions may involve bradic cardia,
5:47:19heart block or constipation particularly
5:47:21with verapamil. Due to these potential
5:47:23complications, CCBs are contraindicated
5:47:25in certain conditions including heart
5:47:27failure as some CCBs may exacerbate it.
5:47:30second or third degree AV block due to
5:47:33the risk of severe brady cardia and
5:47:36hypotension where further lowering a
5:47:38blood pressure could be dangerous. For
5:47:40the enclelex exam, nurses should
5:47:42remember key priorities when dealing
5:47:43with CCBs. If a patient reports
5:47:46dizziness, the first step is to check
5:47:48blood pressure. If it's low, the
5:47:50medication should be held and the
5:47:52provider should be notified.
5:47:54Additionally, verapl is the CCB most
5:47:56likely to cause constipation and
5:47:58patients should be advised to avoid
5:47:59grapefruit juice while taking these
5:48:01medications to prevent toxicity. Now, we
5:48:04will read about beta blockers.
5:48:06Beta blockers are a class of medications
5:48:08primarily used to lower heart rate,
5:48:10reduce blood pressure, and decrease the
5:48:12workload on the heart. By blocking the
5:48:14effects of adrenaline on beta receptors,
5:48:16these drugs help manage several
5:48:18cardiovascular conditions. They are
5:48:20commonly prescribed for hypertension to
5:48:21lower blood pressure and to relieve
5:48:23chest pain and arrhythmias to regulate
5:48:25irregular heartbeats. Additionally, they
5:48:27play a crucial role in preventing future
5:48:29heart issues after a heart attack,
5:48:31managing certain cases of heart failure,
5:48:33and even lowering eye pressure in
5:48:34glaucoma patients. Beyond cardiovascular
5:48:37uses, beta blockers are also effective
5:48:39in preventing migraines.
5:48:42There are two main categories of beta
5:48:44blockers, cardio selective and non-
5:48:46selective. Cardio selective beta
5:48:48blockers such as metaprolol, attenol and
5:48:50esmalol primarily affect the heart and
5:48:53are considered safer for asthma
5:48:54patients. In contrast, non- selective
5:48:56beta blockers including proprenol, timol
5:48:59used in glaucoma and natalol affect both
5:49:02the heart and lungs making them
5:49:03unsuitable for individuals with asthma
5:49:05or chronic obstructive pulmonary disease
5:49:07COPD due to their potential to cause
5:49:10bronco spasms. However, beta blockers
5:49:12are contraindicated in certain
5:49:13conditions. Patients with asthma or COPD
5:49:16should avoid them as they can cause
5:49:18wheezing and breathing difficulties.
5:49:20Similarly, those with brady cardia or a
5:49:23slow heart rate should not take beta
5:49:25blockers as they can further reduce
5:49:27heart rate to dangerously low levels.
5:49:29They are also not recommended for
5:49:31individuals with hypotension as they may
5:49:33further decrease blood pressure and
5:49:35those with second or third degree heart
5:49:37block since they can worsen conduction
5:49:39issues. Furthermore, diabetic patients
5:49:42should use them cautiously because beta
5:49:44blockers can mask the typical symptoms
5:49:45of low blood sugar, such as an increased
5:49:47heart rate, making hypoglycemia harder
5:49:50to detect.
5:49:52When administering beta blockers, it is
5:49:54essential to monitor for potential side
5:49:56effects. Brady cardia or a slow heart
5:49:58rate requires checking the patients
5:50:00pulse before administration with the
5:50:03medication being withheld if the heart
5:50:04rate is below 60 beats per minute.
5:50:07Hypotension necessitates monitoring
5:50:09blood pressure
5:50:13and the drug should be withheld if
5:50:14systolic blood pressure drops below 90
5:50:16millm of mercury. Additionally, non-
5:50:19selective beta blockers can cause bronco
5:50:21spasms, making it critical to avoid
5:50:23their use in asthma patients and to
5:50:24monitor for wheezing or difficulty
5:50:26breathing.
5:50:28Fatigue and dizziness are common
5:50:29initially but often improve over time.
5:50:33Another important consideration is that
5:50:35beta blockers can mask symptoms of
5:50:36hypoglycemia, meaning diabetic patients
5:50:39should be monitored for sweating and
5:50:41confusion rather than relying solely on
5:50:43heart rate. Moreover, erectile
5:50:45dysfunction is a known side effect that
5:50:47may impact medication adherence. To
5:50:49ensure patient safety, several key
5:50:51nursing considerations should be
5:50:52followed. Heart rate and blood pressure
5:50:54should always be checked before
5:50:55administering beta blockers with the
5:50:57medication held if the heart rate is
5:50:59below 60 or blood pressure is below 90
5:51:02over 60 mm of mercury. Patients should
5:51:05never stop taking beta blockers abruptly
5:51:07as this can cause rebound hypertension
5:51:09and tacocardia. For asthma and COPD
5:51:12patients, these drugs should generally
5:51:14be avoided due to the risk of bronco
5:51:16spasm. Diabetic patients must be
5:51:18educated on the potential for beta
5:51:19blockers to mask symptoms of low blood
5:51:21sugar. Lastly, informing patients about
5:51:24possible dizziness and fatigue is
5:51:25important as these side effects are
5:51:27typically temporary and improve over
5:51:30time. Let's move to most important
5:51:31topic. Deoxin. Dyoxin is a cardiac
5:51:33glycoside that plays a crucial role in
5:51:36increasing the strength of heart
5:51:37contractions known as a positive
5:51:39inotropic effect. At the same time, it
5:51:42slows the heart rate and conduction
5:51:43through the AV node, demonstrating a
5:51:45negative chronotropic and droopic
5:51:47effect. As a result, deoxin reduces the
5:51:51overall workload of the heart. However,
5:51:53it is important to note that Deoxin is
5:51:54not a vasodilator, meaning it does not
5:51:57directly widen blood vessels.
5:51:59Clinically, Deoxin is primarily used for
5:52:01two conditions, heart failure and atrial
5:52:04fibrillation, AIB. In heart failure, it
5:52:08enhances the efficiency of the heart's
5:52:09pumping ability, thereby improving
5:52:11circulation and reducing symptoms. In
5:52:14atrial fibrillation, it slows down the
5:52:17rapid heart rate by affecting AV node
5:52:19conduction, helping to maintain a more
5:52:21stable heart rhythm. Since deoxin is
5:52:24excreted primarily through the kidneys,
5:52:26it is essential to monitor kidney
5:52:27function by checking creatinine and
5:52:30blood ura nitrogen bun levels. Patients
5:52:33with impaired kidney function are at a
5:52:36significantly higher risk of dioxin
5:52:38toxicity as the drug can accumulate in
5:52:40the body when not adequately excreted.
5:52:43Dioxin toxicity occurs when levels
5:52:45exceed 2.0 nanogs per milliliter leading
5:52:48to a range of symptoms that progress in
5:52:50severity. The earliest signs are
5:52:51gastrointestinal GI symptoms including
5:52:55nausea, vomiting, loss of appetite,
5:52:57anorexia, and abdominal pain. As
5:53:00toxicity worsens, neurological symptoms
5:53:02may appear such as confusion, weakness,
5:53:05and dizziness. Visual disturbances such
5:53:07as blurred vision, yellow green halos or
5:53:09color changes occur later and are
5:53:11considered a late warning sign. The most
5:53:14dangerous complications of toxicity
5:53:15involve cardiac arhythmias including
5:53:18bradic cardia, heart blocks, and
5:53:20life-threatening ventricular
5:53:21arrhythmias. A key factor that increases
5:53:24the risk of dyin toxicity is
5:53:26hypocalemia, low potassium levels. Since
5:53:29low potassium enhances the drugs effects
5:53:31on the heart, it is crucial to monitor
5:53:33potassium levels, ensuring they remain
5:53:34within the normal range of 3.5 to 5.0
5:53:37mill equivalents per liter. If potassium
5:53:40is low, the risk of toxicity
5:53:42significantly increases, making
5:53:43electrolyte balance a critical aspect of
5:53:46dioxin therapy. Certain patients should
5:53:48not receive dyin due to an increased
5:53:50risk of adverse effects. Contra
5:53:52indications include bradic cardia HR
5:53:55less than 60 beats per minute as digoxin
5:53:57slows the heart further kidney disease
5:53:59which can lead to drug accumulation
5:54:01hypocalemia which heightens toxicity
5:54:03risk and heart blocks where further
5:54:05conduction slowing could be dangerous.
5:54:08Before administering dyoxin nurses must
5:54:10complete several important
5:54:11pre-administration checks. First the
5:54:14apical pulse must be measured for one
5:54:16full minute and dyin should be held if
5:54:18the heart rate is below 60 beats per
5:54:20minute. Additionally, dioxin levels
5:54:22should be checked to ensure they remain
5:54:23within the therapeutic range of 0.5 to
5:54:262.0 NOGS per milliliter. Potassium
5:54:28levels must also be evaluated as low
5:54:30potassium increases the likelihood of
5:54:32toxicity. Finally, kidney function tests
5:54:35creatinine and BUN should be reviewed to
5:54:38assess proper drug excretion. If dioxin
5:54:40toxicity is suspected, immediate
5:54:42intervention is required. If a patient
5:54:44presents with a dioxin level above 2.0 0
5:54:47NOGS per milliliter. Along with
5:54:49symptoms, the drug should be stopped
5:54:50immediately. Continuous heart rhythm
5:54:52monitoring is necessary due to the risk
5:54:54of life-threatening arrhythmias.
5:54:56Electrolyte imbalances, particularly
5:54:58potassium levels, must be corrected to
5:55:00reduce toxicity effects. In cases of
5:55:03severe deoxin toxicity, the antidote
5:55:05dyin immune fab dig is administered to
5:55:08counteract the drug's effects and
5:55:10restore normal cardiac function. Key
5:55:12nursing considerations include
5:55:14consistently monitoring the heart rate
5:55:16before administration, holding the drug
5:55:18if the HR is below 60 beats per minute,
5:55:20and regularly checking deoxin and
5:55:22potassium levels to ensure safe
5:55:24therapeutic ranges.
5:55:26Early signs of toxicity, particularly
5:55:28gastrointestinal symptoms, should not be
5:55:30overlooked. Patients should be educated
5:55:32on recognizing vision changes, nausea,
5:55:34or dizziness as potential warning signs
5:55:36and instructed to avoid over-the-counter
5:55:38medications that lower potassium, such
5:55:40as diuretics and steroids. A common
5:55:43enclelex practice question related to
5:55:45deoxin administration asks, "A nurse is
5:55:48preparing to administer doxin to a
5:55:50patient. Which finding should make the
5:55:52nurse hold the medication?" A potassium
5:55:55level of 4.0 mill equivalents per liter.
5:55:58B. Dioxin level of 1.5 nanogs per
5:56:01milliliter. C. Heart rate of 52 beats
5:56:04per minute. D. Blood pressure of 140
5:56:08over 88 millm of mercury. The correct
5:56:10answer is C. Heart rate of 52 beats per
5:56:13minute because dioxin slows the heart
5:56:15rate. If the HR is below 60 beats per
5:56:17minute, the dose should be held and the
5:56:19provider should be notified to prevent
5:56:21severe bradic cardia or conduction
5:56:23abnormalities. Now we will read about
5:56:25nitroglycerin. Nitroglycerin is one of
5:56:27the most important drugs frequently
5:56:28tested on the NSLEX exam. It is a
5:56:31powerful vasodilator, meaning it widens
5:56:33blood vessels, which helps decrease
5:56:34preload, the workload of the heart, and
5:56:37improves blood flow to the heart.
5:56:38However, due to its strong vasoddilatory
5:56:40effects, it puts patients at risk for
5:56:42hypotension, making blood pressure
5:56:44monitoring crucial. Uses indications
5:56:48nitroglycerin is primarily used for
5:56:50angina chest pain because it improves
5:56:52oxygen delivery to the heart relieving
5:56:54discomfort. It is also beneficial in
5:56:57heart failure as it reduces the strain
5:56:59on the heart by decreasing preload.
5:57:01Additionally, it plays a critical role
5:57:03in hypertensive emergencies where rapid
5:57:05blood pressure reduction is necessary.
5:57:07How to take sublingual nitroglycerin SL
5:57:10tablet or spray
5:57:13for sublingual administration? The
5:57:15standard dosage is one pill every five
5:57:17minutes with a maximum of three doses.
5:57:20If chest pain is not relieved after the
5:57:22first dose, the patient must call
5:57:23emergency services 911 immediately. It
5:57:27is crucial to remember that the pill
5:57:28should not be swallowed but rather
5:57:30placed under the tongue for rapid
5:57:32absorption. Patients should avoid eating
5:57:34or drinking until the medication has
5:57:36fully dissolved.
5:57:38Common side effects. Like any
5:57:39medication, nitroglycerin has side
5:57:41effects. Headache is a common and
5:57:43expected reaction due to blood vessel
5:57:45dilation. Additionally, flushing,
5:57:47redness of the face occurs because of
5:57:49blood vessel relaxation. Patients may
5:57:51also experience dizziness and
5:57:53lightadedness, increasing the risk of
5:57:55falls due to hypotension. A tingling
5:57:57sensation under the tongue is normal and
5:57:59indicates that the medication is working
5:58:01effectively. Nursing considerations.
5:58:04Nurses must closely monitor patients
5:58:06taking nitroglycerin. If a patient
5:58:08reports dizziness or lightadedness, this
5:58:11signals a risk for falls requiring
5:58:13further assessment. Additionally, a
5:58:15significant drop in blood pressure is a
5:58:17serious concern. So, checking blood
5:58:19pressure before administration is
5:58:20essential.
5:58:22Precautions before giving
5:58:25nitroglycerin before administering
5:58:28nitroglycerin. It is crucial to check
5:58:29the patients blood pressure. The drug
5:58:31should be held if the systolic blood
5:58:33pressure SBP is below 90 mm of mercury
5:58:36to prevent severe hypotension. Another
5:58:39critical precaution is assessing whether
5:58:40the patient is taking erectile
5:58:42dysfunction ED medications such as
5:58:44Selenophil Viagra. If the patient has
5:58:48taken Viagra within the last 24 to 48
5:58:50hours, nitroglycerin should not be given
5:58:53as the combination can lead to
5:58:54life-threatening hypotension. Patient
5:58:56education to ensure patient safety.
5:58:59Certain key instructions must be
5:59:01provided. Patients should sit or lie
5:59:03down before taking nitroglycerin to
5:59:05prevent falls caused by dizziness. The
5:59:07medication should be stored in a cool,
5:59:09dark place away from heat and light to
5:59:12maintain its potency. Additionally,
5:59:14nitroglycerin tablets must be replaced
5:59:16every 6 months as older pills lose
5:59:18effectiveness. Alcohol should be avoided
5:59:20as it further increases the risk of low
5:59:22blood pressure. Enclelex practice
5:59:25question. A patient with chest pain is
5:59:27given nitroglycerin. Which statement by
5:59:29the patient requires further teaching?
5:59:32A. I will call 911 if my chest pain
5:59:34doesn't go away after one pill. B. I
5:59:37should keep my medication in a cool,
5:59:39dark place. C. If I get a headache, I
5:59:42should stop taking the medication. D. I
5:59:46should sit down before taking the
5:59:47medication. Correct answer. C. If I get
5:59:50a headache, I should stop taking the
5:59:52medication. Headache is a common side
5:59:55effect of nitroglycerin. The patient
5:59:57should not stop taking the medication
5:59:58due to this side effect. Moving to next
6:00:01drug, NSAIDs or non-steroidal
6:00:04anti-inflammatory drugs are among the
6:00:05most commonly tested medications on the
6:00:07Enclelex exam. These drugs play a
6:00:10crucial role in reducing pain,
6:00:11inflammation, and fever. However, they
6:00:14also come with serious risks that must
6:00:16be carefully managed. Some of the most
6:00:18commonly used nades include ibuprofen,
6:00:21neproxin, aspirin, indomethasin, and
6:00:24ketarolac with the latter being
6:00:26particularly known for its high risk of
6:00:28kidney injury.
6:00:29One of the most significant risks
6:00:31associated with nsaides is
6:00:33gastrointestinal bleeding and peptic
6:00:35ulcers. Patients taking nsades may
6:00:38experience symptoms such as black tarry
6:00:40stools, melena, stomach pain, and
6:00:43hemoteis, vomiting blood.
6:00:46To minimize these risks, it is advisable
6:00:48to take NSAIDs with food to reduce
6:00:50stomach irritation. Avoid alcohol as it
6:00:53increases the likelihood of GI bleeding
6:00:55and consider using a proton pump
6:00:56inhibitor PPI like omerazole for
6:01:00long-term NSAID therapy. In addition to
6:01:02GI complications, NSADs pose a risk of
6:01:05kidney injury nephrotoxicity by reducing
6:01:07blood flow to the kidneys. This makes it
6:01:10essential to monitor kidney function
6:01:11through blood ura nitrogen, bun and
6:01:14creatinine levels, especially in
6:01:15patients with pre-existing kidney
6:01:17disease or dehydration as these
6:01:19conditions further increase the risk of
6:01:21kidney damage. Another major concern is
6:01:23the impact of NSADs on cardiovascular
6:01:26health. These medications can cause
6:01:28fluid retention leading to increased
6:01:30blood pressure and worsening heart
6:01:31failure. Therefore, it is crucial to
6:01:33monitor blood pressure particularly in
6:01:35hypertensive patients and avoid anades
6:01:38in those with heart failure. In cases
6:01:41where pain management is necessary,
6:01:42acetaminophen is often a safer
6:01:44alternative. Furthermore, anades
6:01:47increase the risk of bleeding by
6:01:48inhibiting platelet function. This is
6:01:51particularly concerning for patients
6:01:52taking blood thinners such as warfarin
6:01:54or hepin as well as those scheduled for
6:01:56surgery. Signs of excessive bleeding,
6:01:59including bruising, prolonged bleeding,
6:02:01or black stools, should be closely
6:02:03monitored. Given these risks, certain
6:02:05patient groups should completely avoid
6:02:07NSAIDs. These include individuals with a
6:02:09history of peptic ulcers or GI bleeding,
6:02:11those with kidney disease, patients with
6:02:13hypertension or heart failure,
6:02:15individuals taking blood thinners and
6:02:16COPD patients as aspirin can trigger
6:02:19bronos spasms. To reinforce this
6:02:21knowledge, consider the following
6:02:22enclelex style question. A nurse is
6:02:25caring for a patient with chronic pain
6:02:27and hypertension who takes NSAIDES
6:02:29daily. Which finding requires immediate
6:02:32follow-up? The options are A blood
6:02:35pressure of 152 over 90 mm of mercury, B
6:02:39mild stomach discomfort after eating, C
6:02:41black terry stool, or D swelling in the
6:02:44feet after standing all day. The correct
6:02:46answer is C black terry stool as it
6:02:49indicates GI bleeding a serious
6:02:51complication requiring urgent
6:02:52intervention. Now we will discuss tissue
6:02:55plasmminogen activator TA EPA is a
6:02:58powerful clotbusting drug classified as
6:02:59a thrombolytic. It is primarily used in
6:03:02the treatment of eskeemic stroke,
6:03:03mocardial infarction and pulmonary
6:03:05embolism. However, its effectiveness is
6:03:08time dependent as it must be
6:03:09administered within 3 to 4.5 hours of
6:03:12symptom onset to maximize benefits and
6:03:15minimize complications. Despite its
6:03:17life-saving potential, tpa carries
6:03:19significant risks, particularly in
6:03:21patients with conditions that increase
6:03:23the likelihood of severe bleeding. For
6:03:25this reason, it is contraindicated in
6:03:27individuals who have undergone recent
6:03:28surgery within the past 2 weeks as they
6:03:31face an elevated risk of hemorrhage.
6:03:33Additionally, patients with platelet
6:03:34counts below 100,000 or those with
6:03:37coagulation disorders are at an
6:03:38increased risk of uncontrolled bleeding,
6:03:41making tpa an unsuitable treatment for
6:03:43them. Due to the high potential for
6:03:45bleeding complications, it is essential
6:03:46to closely monitor patients receiving
6:03:48TPA. Neurological assessments are
6:03:51particularly important as any changes in
6:03:53mental status could indicate a brain
6:03:55bleed. To further reduce the risk of
6:03:57bleeding, invasive procedures such as
6:03:59intramuscular injections and Foley
6:04:01catheter insertions should be avoided
6:04:04whenever possible. One of the most
6:04:06critical enclelex tips regarding TPA is
6:04:09that it should never be given for a
6:04:10hemorrhagic stroke. Since tpa dissolves
6:04:13clots, administering it to a patient
6:04:15with active bleeding could lead to
6:04:17catastrophic consequences. Therefore, it
6:04:20is crucial to rule out hemorrhagic
6:04:22stroke with a CT scan before initiating
6:04:24TPA therapy. One of the most important
6:04:26drugs frequently tested on the ENLEX
6:04:28exam is ferrra sulfate, an iron
6:04:30supplement used to treat iron deficiency
6:04:32anemia. To ensure optimal absorption, it
6:04:34should be taken on an empty stomach,
6:04:36ideally 1 hour before or 2 hours after
6:04:38meals. However, certain substances can
6:04:40interfere with its effectiveness. For
6:04:42instance, calcium and antacids reduce
6:04:45iron absorption, so it should never be
6:04:46taken with milk or dairy products. On
6:04:49the other hand, vitamin C enhances
6:04:51absorption, making it beneficial to take
6:04:53iron supplements with orange juice or
6:04:55another source of vitamin C. While
6:04:57ferrro sulfate is effective, it also
6:04:59comes with some common side effects.
6:05:01Constipation is a frequent issue, so
6:05:03patients should be encouraged to
6:05:05increase their fluid and fiber intake.
6:05:07Another common concern is dark or terry
6:05:09stools, but this is a normal effect of
6:05:11iron supplementation and not a sign of
6:05:13bleeding. Some individuals may
6:05:15experience gastrointestinal upset,
6:05:17including nausea and stomach pain. In
6:05:20such cases, taking iron with food may
6:05:22help, although it can slightly decrease
6:05:24absorption. For anlex preparation, it is
6:05:27also essential to remember a few key
6:05:29safety tips. When taking liquid iron,
6:05:31using a straw can prevent teeth
6:05:33staining. Additionally, since iron
6:05:35supplements can be toxic in high doses,
6:05:37they should always be stored out of
6:05:39reach of children to prevent accidental
6:05:40ingestion. Moving to the most important
6:05:43drug category, corticosteroids play a
6:05:45crucial role in reducing inflammation
6:05:47and are commonly used for conditions
6:05:49such as COPD, asthma, and autoimmune
6:05:51diseases. In addition to their
6:05:53anti-inflammatory properties, they also
6:05:55suppress the immune system, making them
6:05:57effective in managing various medical
6:05:59conditions. Some commonly prescribed
6:06:01corticoststeroid drugs include
6:06:02predinisone which is taken orally and
6:06:04dexamethasone which can be administered
6:06:07either orally or intravenously.
6:06:09Hydrocortisone is available in oral,
6:06:11introvenous and topical forms while
6:06:14methyl predniscolone solu is given
6:06:17introvenously. Additionally, fluticosone
6:06:19is an inhaled corticosteroid frequently
6:06:21used for respiratory conditions. A key
6:06:23consideration when administering
6:06:25cortosteroids is their effect on blood
6:06:26sugar levels as they can cause an
6:06:28increase in blood glucose. Therefore, it
6:06:30is essential to monitor glucose levels,
6:06:32particularly in diabetic patients who
6:06:34may require adjustments in their insulin
6:06:36dosage. Another critical point is that
6:06:38cortosteroids must be tapered slowly and
6:06:40never stopped abruptly as sudden
6:06:43discontinuation can lead to adrenal
6:06:45insufficiency. Corticosteroids also come
6:06:47with several common side effects
6:06:49including hypoglycemia which results in
6:06:51high blood sugar levels as well as
6:06:52weight gain and fluid retention. Due to
6:06:55their amunosuppressive effects, they
6:06:57increase the risk of infections making
6:06:59patients more susceptible to illnesses.
6:07:01Long-term use can also weaken bones
6:07:03leading to osteoporosis. Because of
6:07:05these risks, an important enclelex tip
6:07:08is that patients on long-term
6:07:09corticosteroid therapy should report any
6:07:11signs of infection such as fever or sore
6:07:13throat since their immune response may
6:07:16be suppressed. Now, we will explore
6:07:18anti-tubercular drugs. Anti-tubercular
6:07:20drugs play a crucial role in treating
6:07:22tuberculosis by either killing or
6:07:24inhibiting the growth of mcoacterium
6:07:26tuberculosis. These medications are used
6:07:28for both active and latent TB, ensuring
6:07:31effective disease management. The most
6:07:33commonly used anti-tubercular drugs
6:07:34follow the RIP therapy regimen which
6:07:37includes rifampen isazid, pyroinomide
6:07:41and ethampl. Each of these drugs has
6:07:43specific considerations that nurses must
6:07:45be aware of to ensure patient safety and
6:07:47treatment efficacy.
6:07:50One of the most critical nursing
6:07:51considerations is the risk of liver
6:07:53toxicity, hpadotoxicity, which
6:07:55necessitates monitoring liver function
6:07:57tests, including A and ALT. To prevent
6:08:01further liver damage, patients should
6:08:03strictly avoid alcohol and
6:08:04acetaminophen. Another significant side
6:08:07effect is peripheral neuropathy
6:08:08primarily associated with isonia, INH.
6:08:12To mitigate this risk, vitamin B6
6:08:14pyrooxine should be administered to
6:08:16prevent nerve damage. Additionally,
6:08:18rifampen is known to turn body fluids
6:08:20orange, a harmless but notable side
6:08:23effect that does not require
6:08:24discontinuation of the medication.
6:08:26However, patients should be informed
6:08:28that this discoloration can stain
6:08:30contact lenses and clothing.
6:08:32Furthermore, Ethel can cause vision
6:08:34problems, including blurred vision and
6:08:36changes in color perception,
6:08:38particularly green, red color blindness.
6:08:40Any visual disturbances should be
6:08:42promptly reported to a healthcare
6:08:43provider. Patient education is essential
6:08:46for successful TB treatment. To ensure
6:08:48optimal drug absorption, patients should
6:08:50take their medications on an empty
6:08:52stomach. Since these drugs can cause
6:08:54liver damage, alcohol must be strictly
6:08:56avoided. Completing the full course of
6:08:58treatment, which typically lasts 6 to9
6:09:00months, is crucial as stopping early can
6:09:02lead to drug resistance. Moreover, women
6:09:05taking Rafampen should be advised to use
6:09:07backup birth control methods as the drug
6:09:09reduces the effectiveness of oral
6:09:11contraceptives. A key enklex tip
6:09:13involves a patient on isazit who reports
6:09:15tingling in the hands and feet. In this
6:09:17situation, the nurse should administer
6:09:19vitamin B6 pyrooxine to prevent
6:09:22neuropathy, ensuring the patient remains
6:09:24safe while continuing their TB
6:09:26treatment. Now, we will read about
6:09:28tetracycline. Tetracycline is an
6:09:30antibiotic used to treat bacterial
6:09:31infections including skin infections,
6:09:34respiratory infections, sexually
6:09:36transmitted infections, and Lyme
6:09:37disease. When administering
6:09:39tetracycline, it is crucial to take it
6:09:41on an empty stomach, ideally 1 hour
6:09:44before or 2 hours after meals to ensure
6:09:46optimal absorption. Additionally,
6:09:48patients must avoid consuming dairy
6:09:50products, iron supplements, or antacids
6:09:52as these substances significantly reduce
6:09:55drug absorption. To prevent
6:09:57complications such as esophagitis and
6:09:59ulcers, tetracycline should always be
6:10:01taken with a full glass of water.
6:10:03Another key consideration is the risk of
6:10:05photosensitivity which makes patients
6:10:08more susceptible to sunburn. Therefore,
6:10:10they should be advised to wear sunscreen
6:10:12and avoid prolonged sun exposure.
6:10:15Furthermore, tetracycline decreases the
6:10:18effectiveness of birth control, making
6:10:19it essential for patients to use
6:10:21additional contraception as a backup
6:10:23method. Patients must also be educated
6:10:26on avoiding tetracycline before bedtime
6:10:28due to the increased risk of esophageal
6:10:30irritation. Completing the full course
6:10:33of antibiotics is critical to prevent
6:10:35antibiotic resistance and pregnant women
6:10:37or children under eight should not take
6:10:39this medication as it can cause
6:10:42permanent tooth discoloration. A vital
6:10:44enclelex tip involves recognizing the
6:10:47signs of a photosensitivity reaction. If
6:10:49a patient taking tetrayclan reports
6:10:52severe sunburn after brief sun exposure,
6:10:54the nurse should emphasize the
6:10:56importance of wearing sunscreen and
6:10:57protective clothing to minimize the risk
6:10:59of further skin damage. Adenosine is the
6:11:01first line drug for super ventricular
6:11:03tacic cardia and it must be administered
6:11:05as a rapid intravenous push within 1 to
6:11:07two seconds immediately followed by a
6:11:10saline flush. It is crucial to use a
6:11:12large bore IV access in a vein closest
6:11:15to the heart such as the anticubital
6:11:17vein. Patients may experience transient
6:11:20oysis flushing, dizziness or chest
6:11:22discomfort which are expected side
6:11:24effects. Continuous ECG monitoring is
6:11:27essential during administration to
6:11:29ensure patient safety. Moving on to
6:11:32nicardapine, a calcium channel blocker
6:11:34and vaso dilator. It is used to rapidly
6:11:36lower blood pressure in cases of severe
6:11:38hypertension such as poststroke
6:11:41situations where systolic blood pressure
6:11:43exceeds 240 mm of mercury. However,
6:11:47blood pressure should not drop below 170
6:11:49mm of mercury to maintain adequate
6:11:51cerebral profusion. The priority
6:11:53intervention is to monitor for
6:11:55hypotension, dizziness and reflex
6:11:57tacicardia. This medication is
6:11:59administered via IV infusion and the
6:12:01dose must be carefully titrated.
6:12:03Similarly, angotensin 2 receptor
6:12:05blockers arb recognized by their dash
6:12:09sartin suffix such as low sartin are
6:12:11used for hypertension, heart failure and
6:12:13kidney protection in diabetics. However,
6:12:15these drugs are contraindicated in
6:12:17pregnancy due to the potential for fetal
6:12:19harm. A key concern with ORBs is the
6:12:22risk of hypercalemia necessitating
6:12:24regular potassium level monitoring.
6:12:27Additionally, patients should avoid salt
6:12:28substitutes as they often contain
6:12:30potassium. On the other hand, clipidogil
6:12:33an antiplatlet agent prevents platelet
6:12:36aggregation thereby reducing the risk of
6:12:38stroke and heart attack. Before any
6:12:40surgery, it should be discontinued 5 to
6:12:427 days in advance to minimize bleeding
6:12:44risk. Monitoring platelet count is
6:12:47essential and any count below 150,000
6:12:50should be reported to a healthcare
6:12:51provider. Due to its mechanism of
6:12:53action, clipidogil increases bleeding
6:12:55risk, requiring vigilance for signs such
6:12:58as bruising, gastrointestinal bleeding
6:13:00or hematia. When considering cholesterol
6:13:03management, statins play a vital role in
6:13:05lowering LDL cholesterol, total
6:13:07cholesterol, and triglycerides. These
6:13:09medications should be taken at night
6:13:11with an evening meal for optimal
6:13:12absorption. However, a serious side
6:13:14effect includes muscle aches or weakness
6:13:17which could indicate rabdtoiolysis and
6:13:19should be reported immediately.
6:13:22Additionally, liver function should be
6:13:23assessed before initiating therapy.
6:13:26For hypothyroidism treatment,
6:13:28levothyroxine is the standard therapy as
6:13:30it replaces thyroid hormone deficiency.
6:13:32It is safe during pregnancy and crucial
6:13:34for fetal brain development. Patients
6:13:37must take it on an empty stomach in the
6:13:38morning separate from other medications
6:13:40to enhance absorption. Certain
6:13:42substances including calcium, iron, and
6:13:44antacids should be avoided due to their
6:13:46interference with drug absorption.
6:13:49Since levothyroxine is a lifelong
6:13:51therapy, regular TSH monitoring is
6:13:53required with noticeable improvement in
6:13:55symptoms within 3 to 4 weeks and full
6:13:58effect in 6 to 8 weeks. Shifting focus
6:14:01to desmopressin. This medication mimics
6:14:03antidiuretic hormone ADH and reduces
6:14:07urine output. It is used in conditions
6:14:09such as diabetes incipitus, bedwedding
6:14:11and bleeding disorders. However, close
6:14:14monitoring is necessary to prevent water
6:14:15intoxication and hyponetriia which can
6:14:18manifest as headache, confusion or
6:14:21weakness.
6:14:23Severe hyponetriia can lead to seizures,
6:14:25coma or even death making it a critical
6:14:28side effect to watch for. Methtoate
6:14:30commonly used for rheumatoid arthritis
6:14:32and psoriasis functions as an
6:14:34immunosuppressant that reduces
6:14:36inflammation but also increases the risk
6:14:38of infection. Live vaccines should be
6:14:40avoided with only killed vaccines such
6:14:42as flu and pneumonia vaccines being
6:14:44permitted. Additionally, alcohol
6:14:46consumption must be avoided due to the
6:14:47risk of hepatxicity. Since methtriate is
6:14:50highly terattogenic, strict
6:14:52contraception is necessary to prevent
6:14:53pregnancy. Another concern is bone
6:14:55marrow suppression necessitating regular
6:14:57CBC monitoring to assess for anemia
6:14:59infection or bleeding risks. In terms of
6:15:02neurological medications, levitum
6:15:04preaches keer is an anti-convulsant used
6:15:07for seizure prevention. Patients may
6:15:09experience drowsiness and fatigue which
6:15:11usually improve after a few weeks.
6:15:13However, it is crucial to monitor for
6:15:15suicidal ideiation and report any
6:15:17behavioral changes. Furthermore, a
6:15:20serious adverse reaction is Stevens
6:15:22Johnson syndrome. So any rash must be
6:15:24reported immediately. Driving
6:15:26restrictions apply until clearance from
6:15:28a healthcare provider is obtained. For
6:15:30migraine relief, sumatrian works by
6:15:32vasoc constricting cranial blood
6:15:34vessels. However, it is contraindicated
6:15:36in patients with coronary artery disease
6:15:38kadi and uncontrolled hypertension due
6:15:41to the risk of heart attack or stroke. A
6:15:43common side effects include chest
6:15:45pressurees
6:15:48flushing and dizziness which require
6:15:50monitoring. Regarding motion sickness
6:15:52prevention, scopalamine is a trans
6:15:53ddermal patch that should be applied at
6:15:55least 4 hours before travel. It remains
6:15:58effective for 72 hours and should be
6:16:00placed behind the ear. Patients must
6:16:02avoid touching their eyes after handling
6:16:04the patch as it can cause pupil
6:16:06dilation. Midriasis.
6:16:09Phenito, an anti-seizure medication, has
6:16:11a therapeutic range of 10 to 20
6:16:13micrograms per milliliter. Tube feedings
6:16:16decrease its absorption. So it is
6:16:17recommended to pause feedings 1 to two
6:16:19hours before and after administration.
6:16:22Early signs of toxicity include
6:16:24nestagmas, abnormal eye movements and
6:16:26gate instability.
6:16:28Additionally, a common side effect is
6:16:30gingal hyperplasia requiring good oral
6:16:33hygiene. Now bzzoazipines used for
6:16:36anxiety and sedation are typically taken
6:16:38at bedtime due to their seditive
6:16:41effects. Abrupt discontinuation should
6:16:43be avoided as it may lead to withdrawal
6:16:45symptoms including seizures. Midazolam
6:16:48is a benzoazipene commonly used for
6:16:50conscious sedation during procedures and
6:16:53in cases of overdose. Flumazinol serves
6:16:55as the antidote. Lenzalid should be
6:16:58avoided with concurrent use of SSRIs to
6:17:01prevent serotonin syndrome which
6:17:03presents with symptoms such as
6:17:04agitation, hypertension, tacocardia and
6:17:07tremors.
6:17:09Similarly, macrolyte antibiotics like
6:17:11aithramycin, ariththramycin and
6:17:13clariththramycin may cause prolonged QT
6:17:15intervals increasing the risk of cardiac
6:17:17arhythmias. Therefore, ECG monitoring is
6:17:20essential especially in patients with
6:17:22pre-existing heart conditions.
6:17:24Additionally, these antibiotics can lead
6:17:26to hpattoxicity necessitating monitoring
6:17:29of liver enzymes a st
6:17:33for introvenous vancomy trough levels 10
6:17:35to 20 micrograms per milliliter must be
6:17:37checked before administration. The
6:17:39infusion should be given slowly over at
6:17:41least 60 minutes to prevent red man
6:17:44syndrome which manifests as flushing,
6:17:46rash and hypotension.
6:17:48Monitoring blood pressure is crucial as
6:17:50rapid infusion may lead to hypotension.
6:17:53Furthermore, assessing for hyper
6:17:55sensitivity reactions such as rash,
6:17:57itching, and difficulty breathing is
6:17:59important at the severe reactions like
6:18:01anaphilaxis, which includes wheezing,
6:18:03swelling, and angioadema should also be
6:18:05monitored. Checking the IV site every 30
6:18:08minutes is necessary to detect phabitis.
6:18:10And for long-term use, a central venus
6:18:13catheter is preferred. Since vancomycin
6:18:16is nephrotoxic, creatinine levels must
6:18:18be monitored as elevated creatinine
6:18:20indicates toxicity.
6:18:22Docusate sodium is a stool softener that
6:18:24prevents straining thereby reducing
6:18:26stress on the heart. This is
6:18:28particularly important because straining
6:18:29can stimulate the vagus nerve leading to
6:18:32a risk of braticardia especially in
6:18:34cardiac patients. In contrast, fioamide
6:18:37lasix is a commonly used diuretic for
6:18:40heart failure and fluid overload.
6:18:42However, potassium levels should be
6:18:44closely monitored due to the risk of
6:18:45hypocalemia. Additionally, rapid
6:18:47introvenous push administration can
6:18:49cause autotoxicity which presents as
6:18:51tonitis and hearing loss. Ginkoaloba
6:18:54increases the risk of bleeding requiring
6:18:56caution when used with anti-coagulants
6:18:58such as warin and aspirin. A celoxib a
6:19:01coax 2 inhibitor carries a black box
6:19:03warning due to its increased risk of
6:19:05cardiovascular complications including
6:19:07myioardial inffection and stroke. It is
6:19:10important to monitor for symptoms such
6:19:11as back pain, nausea, and vomiting as
6:19:14these may indicate cardiac issues.
6:19:16Morphine on the other hand reduces
6:19:18cardiac workload by decreasing preload
6:19:21and afterload and is used for pain
6:19:23management as well as terminal dispnnea
6:19:26in endstage respiratory distress.
6:19:28Lidocaine when used introvenously
6:19:31decreases cardiac irritability and is
6:19:33indicated for ventricular arhythmias
6:19:34such as ventricular tacocardia. For
6:19:37transdermal patches, general guidelines
6:19:39include avoiding shaving the skin before
6:19:41application to prevent irritation,
6:19:43rotating sights to minimize skin
6:19:44irritation and avoiding heat application
6:19:46over the patch as it can increase
6:19:48absorption and lead to overdose.
6:19:51Specifically, clonedine, an
6:19:52anti-hypertensive patch, should be
6:19:54applied every 7 days, and if dizziness
6:19:56occurs, it should not be removed as this
6:19:58is an expected side effect.
6:20:00Additionally, rotating the application
6:20:02site with each use is necessary to
6:20:04prevent skin irritation. Potassium
6:20:06chloride KCL is available in various
6:20:09forms, including liquid, IV, and
6:20:12extended release tablets. If a patient
6:20:14has difficulty swallowing, a pharmacist
6:20:16should be consulted for alternative
6:20:17forms. Importantly, extended release
6:20:20tablets should never be crushed. When
6:20:22administered introvenously, KCL must be
6:20:24given slowly to avoid cardiac
6:20:26complications. Similarly, the the
6:20:28fentinel patch must be changed every 72
6:20:31hours and to prevent misuse, it should
6:20:33be folded before discarding.
6:20:35Cutting the patch is not advised as it
6:20:37alters drug release and applying heat
6:20:39over it should be avoided due to the
6:20:41risk of overdose. When administering ear
6:20:43drops, the technique varies based on
6:20:45age. For children older than 3 years,
6:20:48the ear should be pulled up and back,
6:20:50while for children younger than three,
6:20:52it should be pulled down and back. After
6:20:54administration, the child should be
6:20:56positioned prone or supine and the drop
6:20:58should be warmed to room temperature to
6:21:00prevent discomfort. The medication
6:21:02should be dropped against the ear canal
6:21:03wall to minimize irritation. For rectal
6:21:06suppository administration, age
6:21:07appropriate distraction techniques
6:21:09should be used. Infants should be
6:21:11positioned supine with knees and feet
6:21:13raised. Older children should be placed
6:21:15in a sidelineing position with knees
6:21:17bent. And toddlers should be engaged
6:21:19with toys. Preschoolers and older
6:21:21children can be encouraged to take deep
6:21:23breaths or count during the procedure.
6:21:25Using a water-soluble lubricant
6:21:27facilitates insertion and for children
6:21:29under 3 years, the fifth finger pinky
6:21:31should be used. Holding the buttocks
6:21:34together briefly after insertion ensures
6:21:36proper absorption. Patient controlled
6:21:38analesia PCA pumps require Y tubing
6:21:41connected with normal saline to keep the
6:21:43vein open. Continuous IV fluids are
6:21:46necessary for proper function and
6:21:47children can use PCA pumps if they
6:21:50understand how they work. Amina, a
6:21:52bronco dilator, has a therapeutic range
6:21:54of 10 to 20 micrograms per milliliter
6:21:57with levels above 20 indicating
6:21:58toxicity. Signs of toxicity include
6:22:01seizures, nausea, tacocardia, and
6:22:04arrhythmias. Isotininoan Accutane used
6:22:07for severe cystic acne resistant to
6:22:09other treatments requires special
6:22:11precautions. Patients should not take
6:22:13vitamin A supplements due to the risk of
6:22:15toxicity. Additionally, blood donation
6:22:18is not allowed while on the medication.
6:22:20Since isotredeninoine is highly
6:22:22terodogenic, requiring two forms of
6:22:24contraception is mandatory to prevent
6:22:26severe birth defects. Thank you for
6:22:28watching this. Before we move ahead, let
6:22:30me take a quick moment to tell you
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6:23:55given in description box. Let's continue
6:23:57the video. Welcome to the maternity and
6:23:59cllex fasttrack course. If you're short
6:24:01on time, this course is for you. Master
6:24:03key maternity concepts quickly and
6:24:05efficiently. Let's get started. Blood
6:24:08pressure monitoring in pregnancy is
6:24:10crucial and nurses should closely
6:24:11observe pregnant clients blood pressure
6:24:13levels. Normally blood pressure
6:24:15decreases gradually during the second
6:24:17trimester and returns to pre-preg levels
6:24:19in the third trimester. However, an
6:24:22increase of more than 15 mm of mercury
6:24:24in diastolic BP or more than 30 mm of
6:24:28mercury in systolic BP before 32 weeks
6:24:31is concerning as it may indicate
6:24:33gestational hypertension or
6:24:34preeclampsia.
6:24:36When managing syphilis during pregnancy,
6:24:38the gold standard treatment is an
6:24:40intramuscular injection of benzathine
6:24:42penicellin G. If a patient is allergic
6:24:44to penicellin, desensitization is
6:24:46necessary as penicellin is the only safe
6:24:49and effective option for treating
6:24:50syphilis during pregnancy. Failure to
6:24:53treat syphilis significantly increases
6:24:55the risk of miscarriage, still birth,
6:24:57preterm birth, and congenital syphilis
6:25:00in the newborn. For estimating the due
6:25:01date, Nagel's rule can be applied using
6:25:04two methods. The first method involves
6:25:06taking the first day of the last
6:25:08menstrual period, LMP, adding 9 months,
6:25:11and then adding 7 days. The second
6:25:14method requires subtracting 3 months
6:25:16from the first day of the LMP and then
6:25:18adding 7 days. However, it is essential
6:25:20to confirm the estimated due date with
6:25:22an ultrasound, particularly in cases of
6:25:25irregular menstrual cycles. Weight gain
6:25:27recommendations during pregnancy vary
6:25:29depending on the trimester and pre-preg
6:25:31BMI. In the first trimester, the
6:25:33expected weight gain is approximately 1
6:25:36lb per month, totaling around 3 to four
6:25:38pounds. During the second and third
6:25:40trimesters, the recommended weight gain
6:25:42is about 1 lb per week. The total weight
6:25:45gain should be 28 to 40 lb for
6:25:47underweight women, 25 to 35 lb for those
6:25:50with a normal BMI, 15 to 25 lb for
6:25:53overweight women, and 11 to 20 lb for
6:25:56obese women. A quick formula to estimate
6:25:58ideal weight gain is weak of gestation
6:26:01minus 9. Constipation is a common issue
6:26:05during pregnancy due to increased
6:26:06progesterone levels which decrease
6:26:08gastric motility and iron supplements
6:26:10which may contribute to constipation.
6:26:13Management strategies include consuming
6:26:15a high-fiber diet with whole grains,
6:26:17fruits, and vegetables, increasing fluid
6:26:19intake, engaging in regular exercise,
6:26:22and using bulk forming fiber supplements
6:26:24such as psyllium. However, pregnant
6:26:26individuals should avoid tea, soda, and
6:26:28caffeine as they can worsen dehydration,
6:26:30and they should not take iron
6:26:32supplements with dairy products as this
6:26:34reduces iron absorption.
6:26:36Regarding alcohol consumption during
6:26:38pregnancy, no amount of alcohol is
6:26:40considered safe. Exposure to alcohol
6:26:42increases the risk of fetal alcohol
6:26:44syndrome, FAS, which can lead to
6:26:46microphille, developmental delays,
6:26:48facial abnormalities, and cognitive
6:26:50impairment. Nurses should educate
6:26:52clients to stop drinking before
6:26:54conception to prevent teratogenic
6:26:56effects. Oligo hydramnio defined as an
6:26:59amniotic fluid index AFI of less than 5
6:27:02cm can result from placental
6:27:04insufficiency, premature rupture of
6:27:06membranes, prom or fetal renal
6:27:08abnormalities such as renal agenesis or
6:27:10Potter syndrome. This condition can lead
6:27:12to complications including umbilical
6:27:14cord compression which causes variable
6:27:16decelerations on fetal heart rate
6:27:18monitoring, pulmonary hypoplasia. If
6:27:20oligo hydramnio occurs early and
6:27:22restricted fetal movement which may
6:27:24result in limb contraures. Diagnosis is
6:27:27confirmed via ultrasound and management
6:27:29strategies include amno infusion in
6:27:31cases of fetal distress, close
6:27:33monitoring of fetal growth and
6:27:34well-being and hydration therapy using
6:27:36oral or IV fluids for mild cases. Anemia
6:27:39in pregnancy is a common complication
6:27:41often resulting from iron deficiency.
6:27:44The diagnostic criteria include
6:27:45hemoglobin levels below 11 g per
6:27:47deciliter in the first and third
6:27:48trimesters or below 10.5 g per deciliter
6:27:51in the second trimester. While a
6:27:53hematocrit level below 33% also
6:27:56indicates anemia. One notable symptom
6:27:59associated with iron deficiency anemia
6:28:01is pika which refers to an abnormal
6:28:04craving for non-nutritive substances
6:28:06such as ice, clay or starch. To diagnose
6:28:10anemia, healthcare providers order
6:28:11hemoglobin and hematocrit tests as a
6:28:13screening measure. Management involves
6:28:15iron supplementation which is best
6:28:17absorbed when taken with vitamin C.
6:28:20Additionally, consuming iron rich foods
6:28:22such as red meat, poultry, fish, leafy
6:28:25green vegetables, beans, lentils, and
6:28:27iron fortified cereals is essential.
6:28:29However, calcium richch foods like milk
6:28:31and cheese should be avoided around the
6:28:33time of iron intake as they can inhibit
6:28:35absorption. Proper nutrition during
6:28:37pregnancy is crucial with essential
6:28:39nutrients playing a key role in maternal
6:28:41and fetal health. Folic acid found in
6:28:44leafy greens, citrus fruits, beans, and
6:28:46fortified cereals helps prevent neural
6:28:48tube defects. Iron, which prevents
6:28:51anemia, is abundant in red meat,
6:28:53spinach, legumes, and fortified grains.
6:28:55Whole grains such as brown rice, whole
6:28:57wheat bread, and oats provide energy and
6:28:59aid digestion, while omega-3 fatty acids
6:29:02from sources like salmon, flax seeds,
6:29:04and walnuts support fetal brain
6:29:05development. Conversely, certain foods
6:29:08should be avoided due to potential
6:29:09risks. Unpasteurized dairy poses a
6:29:12lististeria risk, while raw or
6:29:14undercooked meat, eggs, and fish
6:29:16increase the chances of salmonella and
6:29:18toxoplasmosis infections. Deli meats and
6:29:20hot dogs should be reheated to steaming
6:29:22to eliminate the risk of lististeria.
6:29:24High mercury fish including shark,
6:29:26swordfish, king mackerel and tilefish
6:29:29should also be avoided along with liver
6:29:31as excessive vitamin A intake can lead
6:29:33to birth defects. Hypertensive disorders
6:29:36in pregnancy require careful monitoring
6:29:38as they pose risks to both the mother
6:29:40and baby. Gestational hypertension is
6:29:43characterized by new onset blood
6:29:44pressure of 140 over 90 millm of mercury
6:29:48or higher after 20 weeks of gestation
6:29:50without proteinura or end organ damage.
6:29:54Preclampsia on the other hand presents
6:29:56with elevated blood pressure along with
6:29:58proteinura or signs of organ dysfunction
6:30:01such as elevated liver enzymes and renal
6:30:03impairment. Symptoms include headaches,
6:30:06facial swelling and visual disturbances
6:30:08like blurry vision and scotoomas. If
6:30:11preeacclampsia progresses to eclampsia
6:30:12which is marked by seizures, it becomes
6:30:14a medical emergency requiring magnesium
6:30:17sulfate to prevent further seizures.
6:30:19Another serious condition in pregnancy
6:30:21is disseminated intravascular
6:30:23coagulation DIC which is associated with
6:30:26high- risk factors such as placental
6:30:28abruption, fetal demise, severe
6:30:30preeacclampsia and amniotic fluid
6:30:32embolism. The underlying pathophysiology
6:30:35involves widespread clotting that
6:30:36depletes clotting factors leading to
6:30:39uncontrolled bleeding. Clinical
6:30:40manifestations include excessive
6:30:42bleeding at IV sites, gums, and surgical
6:30:44wounds as well as internal bleeding
6:30:46indicated by pitiki, echimosis, and
6:30:49hematia. Additionally, patients may
6:30:51exhibit shock symptoms such as
6:30:53hypotension and tacocardia. Management
6:30:56involves obtaining baseline coagulation
6:30:58labs including PT, a PTT, fibrogen,
6:31:01platelets, and d-dimer levels along with
6:31:03the administration of blood products
6:31:05such as fresh frozen plasma and
6:31:06platelets. Ectopic pregnancy where a
6:31:09fertilized egg implants outside the
6:31:11uterus, most commonly in the fallopian
6:31:13tube, is another critical condition
6:31:15requiring prompt intervention. Symptoms
6:31:17include severe unilateral abdominal or
6:31:20pelvic pain as well as referred shoulder
6:31:22pain due to blood irritating the
6:31:23diaphragm. If rupture occurs, patients
6:31:26may develop hypotension, dizziness, and
6:31:28tacocardia necessitating emergency
6:31:30surgery. In cases where the ectopic
6:31:32pregnancy is unruptured and there is no
6:31:34fetal cardiac activity, methtoresate is
6:31:36administered as a medical management
6:31:38option. However, a ruptured ectopic
6:31:40pregnancy requires emergency
6:31:42laparoscopic surgery to prevent further
6:31:44complications. Fetal heart rate
6:31:45monitoring is essential for assessing
6:31:47fetal well-being. It can be detected by
6:31:50a Doppler as early as 10 to 12 weeks of
6:31:52gestation with a normal fetal heart rate
6:31:54ranging between 110 and 160 beats per
6:31:57minute. Abnormal patterns indicate
6:31:59potential complications such as brady
6:32:01cardia defined as an fetal heart rate
6:32:03below 110 beats per minute which may be
6:32:06caused by fetal hypoxia, maternal
6:32:08hypotension or umbilical cord
6:32:09compression. Conversely, tacocardia
6:32:12characterized by infetal heart rate
6:32:13exceeding 160 beats per minute can
6:32:16result from maternal fever, infection or
6:32:18fetal distress. Monitoring and timely
6:32:21interventions are crucial to ensuring a
6:32:22healthy pregnancy outcome. Placenta
6:32:24abruptio presents with a sudden onset of
6:32:27vaginal bleeding, severe abdominal pain,
6:32:30uterine tenderness, and hypertonic
6:32:32contractions. This condition occurs due
6:32:34to the premature separation of the
6:32:36placenta from the uterine wall leading
6:32:39to hemorrhage, fetal distress, and
6:32:41maternal complications. Several risk
6:32:43factors contribute to placenta abruptio
6:32:45including hypertension, preeclampsia,
6:32:47trauma, smoking, cocaine use, prior
6:32:50abruption, and advanced maternal age.
6:32:52The complications can be severe with
6:32:54risks such as disseminated intravascular
6:32:57coagulation, DIC, fetal hypoxia, and
6:33:00maternal hemorrhagic shock. Management
6:33:03involves continuous fetal monitoring,
6:33:04fluids, and blood transfusion if
6:33:06necessary. In cases of fetal distress or
6:33:09significant hemorrhage, an emergency
6:33:10C-section is required. In contrast,
6:33:13placenta pva is characterized by
6:33:15painless vaginal bleeding, typically
6:33:16occurring in the second or third
6:33:18trimester. Diagnosis is confirmed
6:33:20through ultrasound which reveals the
6:33:22placenta covering or near the cervical
6:33:24OS. Risk factors for placenta previa
6:33:27include a history of prior C-section,
6:33:29multiple gestations, uterine scarring,
6:33:31smoking, and advanced maternal age.
6:33:33Management strategies focus on pelvic
6:33:35rest, which includes avoiding douching,
6:33:37vaginal exams, and intercourse.
6:33:39Additionally, large bore intravenous
6:33:41access is essential for potential fluid
6:33:43resuscitation, and serial ultrasounds
6:33:45are conducted to monitor placenta
6:33:47position. A C-section is planned after
6:33:4936 weeks before the onset of labor. A
6:33:52key nursing tip to remember is that a
6:33:54vaginal exam should never be performed
6:33:55in a patient with suspected placenta
6:33:57privia due to the risk of severe
6:33:59hemorrhage. Preterm birth defined as
6:34:01birth before 37 weeks of gestation has
6:34:04multiple risk factors with the most
6:34:05significant being a history of prior
6:34:07preterm birth. Other contributing
6:34:10factors include previous cervical
6:34:12surgery such as cone biopsy or LEAP
6:34:14procedure, tobacco, alcohol or drug use,
6:34:16and maternal age below 17 or above 35
6:34:19years. Additionally, black race is
6:34:22associated with a higher risk due to
6:34:24health disparities and an increased
6:34:26inflammatory response. Infections such
6:34:28as urinary tract infections, UTI,
6:34:31bacterial vaginosis and choreoamnitis
6:34:34as well as periodontal disease have been
6:34:36linked to systemic inflammation and
6:34:38preterm labor. Multiple gestations
6:34:40including twins or triplets also
6:34:42increase the risk. Management strategies
6:34:45include progesterone therapy to prevent
6:34:47preterm labor in high-risisk patients.
6:34:49cervical cage for cervical incompetence
6:34:52uh defined as less than 25 millm and
6:34:55corticosteroids like betamethasone to
6:34:57promote fetal lung maturity if preterm
6:34:59birth is imminent. Furthermore,
6:35:01toxolytics such as nifidapine,
6:35:03indomethasin and tbutiline are used to
6:35:06delay labor. Regarding vaccines in
6:35:08pregnancy, certain vaccines are safe and
6:35:10recommended while others are
6:35:12contraindicated.
6:35:13Safe vaccines include the inactivated
6:35:16influenza vaccine, flu shot, and the
6:35:18TDAP vaccine, which is administered
6:35:21between 27 and 36 weeks to provide
6:35:24passive immunity to the newborn.
6:35:25However, live vaccines should be avoided
6:35:27during pregnancy, including the
6:35:29influenza nasal spray, MMR, measles,
6:35:32mumps, reubella, and vicella vaccines.
6:35:35Additionally, pregnancy should be
6:35:37avoided for at least 4 weeks after
6:35:39receiving a live vaccine. Hyperemesis
6:35:41gravidarum or severe morning sickness is
6:35:44characterized by persistent nausea and
6:35:46vomiting leading to dehydration and
6:35:48weight loss. Clinical features include
6:35:50weight loss exceeding 5% of pre-reg
6:35:53weight and signs of dehydration such as
6:35:55poor skin tore, dry mucous membranes,
6:35:57tacicardia and hypotension. Electrolyte
6:36:00imbalances are common with findings such
6:36:02as hypocalemia, hyponetriia and keonura
6:36:06due to starvation and fat breakdown.
6:36:08Additionally, increased urine specific
6:36:10gravity is noted due to dehydration
6:36:12while metabolic alkyossis occurs as a
6:36:15result of excessive vomiting and gastric
6:36:17acid loss. Management involves IV fluid
6:36:20administration using normal saline or
6:36:22lactated ringers solution with
6:36:24electrolyte replacement. The first line
6:36:26treatment includes vitamin B6 combined
6:36:28with doxyamine while antiimetics such as
6:36:30undancatron, zopran, metacopramide and
6:36:33prothazine may also be used in cases of
6:36:36prolonged vomiting. Thamine
6:36:37supplementation is necessary to prevent
6:36:39vernikica and sephylopathy. Prenatal
6:36:42teaching is essential for ensuring a
6:36:43healthy pregnancy and it includes
6:36:45guidance on healthcare provider HCP
6:36:47visits, laboratory values, common
6:36:49conditions, and necessary interventions.
6:36:52Regular prenatal visits follow a
6:36:54structured schedule once a month until
6:36:55week 28, then every 2 weeks until week
6:36:5837, and weekly from week 37 until
6:37:01delivery.
6:37:02If labor has not started by week 42, the
6:37:05healthcare team considers induction or a
6:37:07cescareian section. Alongside these
6:37:09visits, monitoring hemoglobin levels is
6:37:11crucial as normal values vary across
6:37:13trimesters. During the first trimester,
6:37:16hemoglobin can be as low as 11 g per
6:37:18deciliter while in the second and third
6:37:20trimesters levels may drop to 10.5 g per
6:37:23deciliter due to hemodilution. However,
6:37:25if levels fall below 10 g per deciliter,
6:37:28anemia is diagnosed necessitating iron
6:37:31supplementation. Another important
6:37:33condition in pregnancy is intrahypatic
6:37:35cholesttosis of pregnancy ICP. A liver
6:37:38disorder that causes intense itching
6:37:40particularly on the hand S and feet
6:37:42which worsens at night. Though it
6:37:44presents without a rash, ICP increases
6:37:47the risk of fetal distress, preterm
6:37:49birth and still birth. Because of these
6:37:51risks, it requires close monitoring of
6:37:53bile acid levels. Management includes
6:37:56administering ursodioxycolic acid udca
6:37:59to reduce bile acids and performing
6:38:01frequent fetal assessments such as
6:38:02non-stress tests NST and biohysical
6:38:06profiles BPP. In severe cases, early
6:38:09delivery at 37 weeks is recommended.
6:38:12Another essential prenatal test is the
6:38:13indirect test which screens for Rh
6:38:16sensitization in Rh- negative mothers
6:38:19such as those with an O negative blood
6:38:21type. If maternal and fetal blood mix
6:38:23due to trauma, amnocentesis, abortion,
6:38:26ectopic pregnancy or delivery, an Rh-
6:38:29negative mother may develop antibodies
6:38:31against an Rh- positive fetus. This can
6:38:34lead to hemolytic disease of the newborn
6:38:36HDN. To prevent this, Rhim immune
6:38:39globulin rogam is administered at 28
6:38:42weeks of gestation within 72 hours
6:38:44postpartum if the newborn is Rh-
6:38:46positive and after any event that may
6:38:49cause fetal maternal blood mixing.
6:38:51Nutritional support is also a key aspect
6:38:53of prenatal care with folic acid,
6:38:56vitamin B9 playing a vital role in
6:38:58preventing neural tube defects NTDs such
6:39:01as spinobipida and ansephille. Women
6:39:05planning pregnancy and those in the
6:39:06first trimester should consume 400 to
6:39:08800 micrograms of folic acid daily. This
6:39:11can be obtained from fortified grains
6:39:13such as cereal, bread, and pasta, as
6:39:15well as leafy green vegetables like
6:39:17spinach, kale, and asparagus. Other good
6:39:20sources include legumes like lentils,
6:39:22chickpeas, and black beans along with
6:39:24citrus fruits such as oranges, and
6:39:26papaya. In addition to these key topics,
6:39:29understanding funal height measurements
6:39:30is helpful in assessing fetal growth. By
6:39:3312 weeks, the fundus is just above the
6:39:35pubic symphysis. At 20 weeks, it reaches
6:39:37the umbilicus, and after 20 weeks, it
6:39:39typically grows about 1 cm per week with
6:39:42a normal variation of plus or minus 2
6:39:44cm. Another important indicator of fetal
6:39:46well-being is kick counts, where
6:39:48expecting mothers should feel at least
6:39:5010 fetal movements within 2 hours. If
6:39:52fewer than 10 kicks are detected,
6:39:54drinking cold water, resting, and
6:39:56reassessing may help. However, if fetal
6:39:59movements remain reduced, immediate
6:40:01contact with the health care provider is
6:40:03necessary. Finally, recognizing danger
6:40:06signs in pregnancy is critical for early
6:40:08intervention. Symptoms requiring
6:40:10immediate evaluation include severe
6:40:11headache, vision changes, epigastric
6:40:14pain, or right upper quadrant pain,
6:40:16which may indicate preeacclampsia.
6:40:18Painless vaginal bleeding could suggest
6:40:20placenta privia while a sudden gush of
6:40:22fluid before 37 weeks may signal preterm
6:40:25premature rupture of membranes. PP ROM
6:40:28ROM. Additionally, decreased fetal
6:40:31movements necessitate urgent fetal
6:40:32monitoring to ensure the baby's
6:40:34well-being. By staying informed about
6:40:36these essential aspects of prenatal
6:40:38care, expectant mothers can help ensure
6:40:40a safe and healthy pregnancy. Measuring
6:40:42funal height is an essential aspect of
6:40:44prenatal assessment as it helps estimate
6:40:46gestational age. After 20 weeks of
6:40:49pregnancy, the funal height in
6:40:50centimeters approximately corresponds to
6:40:53the number of weeks pregnant. To ensure
6:40:55an accurate measurement, the bladder
6:40:57should be emptied to prevent distortion
6:40:59and the client should be positioned
6:41:00supine with knees slightly flexed. A
6:41:03non-elastic measuring tape is then used
6:41:05to measure from the symphysis pubis to
6:41:07the highest point of the fundus. The
6:41:09position of the fundus changes with
6:41:11gestational age, making it a useful
6:41:13indicator of fetal growth. At 12 weeks,
6:41:16the fundus is just above the symphysis
6:41:18pubis, while by 16 weeks, it is midway
6:41:20between the symphysis pubis and the
6:41:22umbilicus. By 20 to 22 weeks, the fundus
6:41:25reaches the level of the umbilicus, and
6:41:26at 36 weeks, it approaches the zyphoid
6:41:29process. However, after 37 to 40 weeks,
6:41:32the funal height may decrease as
6:41:34slightly as the baby engages in the
6:41:36pelvis, a phenomenon known as lightning.
6:41:40In addition to funal height, quickening
6:41:41or the first fetal movement is another
6:41:43milestone in pregnancy. This typically
6:41:46occurs around 18 to 20 weeks in
6:41:48primigravita firsttime pregnancies and
6:41:51as early as 14 to 16 weeks in
6:41:53multigravida subsequent pregnancies.
6:41:55Recognizing these changes helps in
6:41:57monitoring fetal development and
6:41:58maternal well-being. A crucial
6:42:00consideration during pregnancy is
6:42:02uterine displacement and the risk of
6:42:04supine hypotension. If a pregnant client
6:42:07lies flat on their back, the uterus can
6:42:09compress the inferior venneava, reducing
6:42:12blood return to the heart and leading to
6:42:14hypotension, palar and dizziness. To
6:42:16prevent this, the first intervention is
6:42:18to tilt the client laterally, preferably
6:42:21to the left side. This positioning is
6:42:23also vital in emergency pregnancy trauma
6:42:25care where lateral tilting should be
6:42:27done before initiating resuscitation
6:42:29efforts to maintain adequate profusion
6:42:31to both the fetus and the mother.
6:42:33Medication use during pregnancy requires
6:42:35caution, especially with NSAIDs. In the
6:42:38first and second trimesters, NSAIDs are
6:42:40classified as category C, meaning they
6:42:42should only be used if the benefits
6:42:44outweigh the risks. However, in the
6:42:46third trimester, they fall under
6:42:47category D and should be avoided due to
6:42:49the risk of premature closure of the
6:42:51ductus arteriosis and oligohydramnio.
6:42:54Instead, acetaminophen, Tylenol, is
6:42:56recommended as a safer alternative for
6:42:58pain relief. Hypertensive disorders of
6:43:00pregnancy such as preeacclampsia and
6:43:02eclampsia pose significant risks to both
6:43:04mother and baby. Preeclampsia is
6:43:07characterized by hypertension, blood
6:43:08pressure greater than 140 over 90 and
6:43:11proteinura greater than 300 mg per
6:43:1424-hour urine while eclampsia involves
6:43:17seizures occurring after 20 weeks of
6:43:19gestation. The only definitive cure is
6:43:22delivery. However, magnesium sulfate is
6:43:24used to prevent and control seizures.
6:43:27Its therapeutic level ranges from 4 to 7
6:43:29mill equivalents per liter 2.0 to 3.5
6:43:33millm moles per liter and deep tendon
6:43:36reflexes DTRs should be closely
6:43:38monitored for signs of toxicity. If
6:43:41magnesium toxicity occurs, calcium
6:43:43gluconate serves as the antidote during
6:43:45a seizure. It is crucial to turn the
6:43:47client on their left side, maintain a
6:43:49patent airway, and monitor for
6:43:50respiratory depression, respiratory rate
6:43:52less than 12 per minute, and urine
6:43:54output less than 30 milliliters per
6:43:57hour, both of which may indicate
6:43:59magnesium toxicity. Another common
6:44:02pregnancy symptom is morning sickness,
6:44:04typically occurring in the first
6:44:05trimester due to increased levels of
6:44:07human corionic gonadotropen, HCG, and
6:44:10estrogen. To alleviate nausea and
6:44:13vomiting, eating dry carbohydrates such
6:44:15as crackers or toast, before getting out
6:44:18of bed, consuming high protein snacks
6:44:20before bedtime, and having small
6:44:22frequent meals are effective strategies.
6:44:24Additionally, drinking cold carbonated
6:44:27fluids between meals, and incorporating
6:44:28ginger and vitamin B6 rich foods such as
6:44:31nuts, seeds, and legumes can help reduce
6:44:33nausea. Gestational diabetes malitis,
6:44:36GDM, is another condition that requires
6:44:38screening between 24 to 28 weeks of
6:44:40pregnancy. The initial test is a 1-hour
6:44:43glucose tolerance test, which involves
6:44:45drinking a 50 g glucose solution without
6:44:47the need for fasting. A normal result is
6:44:50less than 140 mg per deciliter, whereas
6:44:53an abnormal result greater than 140 mg
6:44:55per deciliter necessitates a 3-hour
6:44:57glucose tolerance test for further
6:44:59evaluation. If left untreated, GDM can
6:45:03lead to complications such as
6:45:04macrosomia, neonatal hypoglycemia, and
6:45:07respiratory distress in the newborn.
6:45:09Another important screening in pregnancy
6:45:11is for group B streptococcus, GBS, a
6:45:14normal vaginal flora found in
6:45:16approximately 30% of women, but one that
6:45:18can cause neonatal sepsis and pneumonia.
6:45:21Testing is done between 35 to 37 weeks,
6:45:24and if positive, intravenous penicellin
6:45:26G is the preferred treatment during
6:45:28labor. For clients allergic to
6:45:30penicellin, clintomy or vankcomy can be
6:45:33used as alternatives. If GBS status is
6:45:36unknown, empirical treatment is
6:45:38recommended if risk factors such as
6:45:40preterm labor, prolonged rupture of
6:45:42membranes greater than 18 hours, or
6:45:45maternal fever are present.
6:45:47Finally, pyrosis, heartburn, is a common
6:45:50pregnancy discomfort caused by increased
6:45:52progesterone, which relaxes the lower
6:45:54esophageal sphincter and the enlarging
6:45:57uterus, which pushes the stomach upward.
6:46:00To prevent and manage heartburn, keeping
6:46:02the head of the bed elevated, staying
6:46:03upright for 30 to 60 minutes after meals
6:46:05and eating small frequent meals can be
6:46:08beneficial. Additionally, avoiding large
6:46:10meals, fried or fatty foods, caffeine,
6:46:12and chocolate helps reduce symptoms. The
6:46:15MMR measles mumps reubella vaccine is
6:46:18administered only during the postpartum
6:46:19period if the mother was not previously
6:46:21vaccinated. Since it is a live vaccine,
6:46:24it is contraindicated during pregnancy
6:46:25due to its terodogenic effects.
6:46:28Furthermore, women who receive this
6:46:30vaccine should avoid pregnancy for at
6:46:32least 1 to 3 months after administration
6:46:34to prevent any potential risks to the
6:46:36fetus. Another important obstetric
6:46:39procedure is circlage which is placed in
6:46:42cases of cervical insufficiency to
6:46:44prevent preterm labor. After the
6:46:46procedure, bed rest is required only for
6:46:48the first few days. However, the patient
6:46:50should report any signs of labor such as
6:46:52lower back pain, contractions, pelvic
6:46:54pressure, or rupture of membranes to
6:46:56their health care provider, HCP.
6:46:59Typically, circlage remains in place
6:47:01until 36 to 37 weeks of gestation, but
6:47:03early removal is necessary if preterm
6:47:06labor or rupture of membranes occurs. In
6:47:09cases of spontaneous abortion,
6:47:11miscarriage, defined as unintentional
6:47:13pregnancy loss before 20 weeks of
6:47:15gestation, patients should follow
6:47:17specific nursing care instructions. They
6:47:19should avoid tampons and sexual
6:47:21intercourse for 2 weeks and report any
6:47:22severe pain, foul smelling discharge, or
6:47:25heavy bleeding. Continuing prenatal
6:47:27vitamins and increasing iron intake are
6:47:29recommended while ibuprofen can be taken
6:47:31for pain relief. Additionally, Rh
6:47:34imunogloabbulin ro gam is required for
6:47:37Rh negative mothers to prevent
6:47:39isoimmunization.
6:47:41Certain medications such as ACE
6:47:42inhibitors and ARBs should be avoided
6:47:45during pregnancy due to their risk of
6:47:46causing fetal renal dysfunction and
6:47:48congenital defects. Moreover, laboratory
6:47:51values like WBC count tend to be
6:47:54normally elevated during pregnancy, even
6:47:56in the absence of infection, which
6:47:58should be considered when interpreting
6:48:00lab results. During labor, the phases of
6:48:03labor are categorized into three stages.
6:48:05The latent phase 0 to 3 cm dilation
6:48:09involves mild irregular contractions,
6:48:11and the mother is generally comfortable.
6:48:14As labor progresses to the active phase,
6:48:164 to 7 cm dilation, contractions become
6:48:19stronger and more regular, occurring
6:48:21every 3 to 5 minutes, often requiring
6:48:23pain management, such as epidural
6:48:25administration. The transition phase, 8
6:48:28to 10 cm dilation, is characterized by
6:48:31intense contractions every 1 to 2
6:48:33minutes, increased pressure, and the
6:48:34urge to push. To induce labor or prevent
6:48:38postpartum hemorrhage, oxytocin ptocin
6:48:40is commonly used, but it requires
6:48:42continuous fetal and maternal monitoring
6:48:45due to its potential risks. These
6:48:47include uterine hyper stimulation,
6:48:49contractions lasting more than 90
6:48:51seconds or occurring less than 2 minutes
6:48:52apart, abnormal fetal heart rate
6:48:55patterns such as bradicardia and
6:48:57decelerations, and increased risks for
6:48:59emergency C-section, placental
6:49:01abruption, or uterine rupture.
6:49:03Additionally, oxytocin has antidiuretic
6:49:06effects which can lead to water
6:49:07intoxication. It should always be
6:49:09administered via a secondary IV line and
6:49:12should not be given with other uteronic
6:49:13medications like misoprosttol. On the
6:49:16other hand, toxolytics are used to stop
6:49:18labor in preterm cases. Magnesium
6:49:20sulfate is administered for
6:49:22neuroproction and preterm labor
6:49:23management, but monitoring for
6:49:25hypermagnia is essential. Symptoms
6:49:28include decreased heart rate, blood
6:49:30pressure, reflexes, respiratory rate,
6:49:33and level of consciousness. Reflexes
6:49:35should be maintained at plus two. If
6:49:37decreased, the infusion should be slowed
6:49:39and if increased, the dosage should be
6:49:41adjusted. Another talytic tbutiline is
6:49:45used for short-term preterm labor
6:49:47management, but may cause maternal
6:49:49teacardia. When preterm labor occurs
6:49:51before 34 weeks gestation, several
6:49:54interventions are anticipated. IM
6:49:56antiatal gluccocorticoids some drugs are
6:49:59administered to mature fetal lungs while
6:50:01IV antibiotics penicellin are given as
6:50:04prophylaxis for group B streptococcus
6:50:07yeah GBS if the pregnancy is under 32
6:50:10weeks magnesium sulfate is used for
6:50:12fetal neurop protection Importantly
6:50:15artificial rupture of membranes a ro
6:50:18should be avoided to prevent umbilical
6:50:20cord prolapse in cases where umbilical
6:50:23cord prolapse does occur it leads to to
6:50:25abrupt fetal heart rate deceleration,
6:50:28fetal bradic cardia, and oxygen
6:50:30disruption. The priority interventions
6:50:32include performing a sterile vaginal
6:50:33exam to assess cord compression, and
6:50:35repositioning the patient into a knee,
6:50:37chest, or trendelenberg position to
6:50:39relieve pressure on the cord. In most
6:50:41cases, an emergency C-section is
6:50:43required to ensure fetal safety. Another
6:50:46important consideration in labor is the
6:50:48mucus plug, whose expulsion is not
6:50:50necessarily a definitive sign of labor.
6:50:53To determine the likelihood of a
6:50:54successful vaginal delivery, the Bishop
6:50:56score is used with a score greater than
6:50:58six to eight indicating better readiness
6:51:00for labor induction. For pain relief
6:51:02during the late second stage of labor, a
6:51:04podendal nerve block is a highly
6:51:06effective option, especially when rapid
6:51:08relief is needed before birth.
6:51:10Similarly, an amniottomy, a artificial
6:51:14rupture of membranes is performed to
6:51:16induce or accelerate labor, but comes
6:51:18with risks such as umbilical cord
6:51:20prolapse and infection. Therefore,
6:51:22nursing actions include assessing fetal
6:51:24heart rate before and after the
6:51:26procedure, checking the characteristics
6:51:27of amniotic fluid, color, odor, presence
6:51:30of mcconium, and encouraging the mother
6:51:32to maintain an upright sitting position,
6:51:34but uh post procedure. Shoulder dystocia
6:51:37is a medical emergency that occurs when
6:51:38the fetal shoulder becomes lodged behind
6:51:40the maternal symphysis pubis, preventing
6:51:42delivery. Immediate interventions are
6:51:44crucial to prevent fetal hypoxia and
6:51:46other complications. During such an
6:51:48emergency, nursing interventions include
6:51:51precisely documenting the times of
6:51:52events and verbalizing the passing time
6:51:54every five minutes to maintain
6:51:56awareness. Additionally, requesting
6:51:58extra assistance from the healthcare
6:52:00team ensures timely and effective
6:52:02management. Maneuvers such as the
6:52:04McRoberts maneuver, which involves
6:52:05flexing the maternal thighs to the
6:52:07abdomen and applying super pubic
6:52:09pressure to dislodge the shoulder, are
6:52:11essential. However, funal pressure must
6:52:13be strictly avoided as it may worsen the
6:52:15impaction. To improve fetal profusion
6:52:18and oxygenation, certain steps should be
6:52:20taken. If fetal distress is noted,
6:52:23discontinuing oxytocin, ptocin, can help
6:52:26mitigate further complications.
6:52:28Repositioning the client to the left
6:52:30lateral side enhances circulation while
6:52:32administering oxygen at 8 to 10 L per
6:52:35minute via a non-rebreather mask ensures
6:52:37adequate oxygenation. Additionally,
6:52:39providing an IV bololis of lactated
6:52:41ringers solution or normal saline
6:52:43supports maternal hemodynamic stability.
6:52:46However, when an epidural block is used
6:52:48for pain management, it can inhibit the
6:52:50sympathetic nervous system leading to
6:52:52vasoddilation and potential hypotension.
6:52:55Therefore, monitoring for signs of
6:52:57lightadedness, dizziness, nausea or
6:52:59hypotension is essential. The first step
6:53:02in such cases is to assess the client's
6:53:04blood pressure and if hypotension
6:53:06occurs, interventions should include
6:53:08intravenous fluid administration, left
6:53:10lateral positioning, oxygen
6:53:12supplementation, and notifying the
6:53:14provider. When administering introvenous
6:53:17opioids in labor, timing is critical to
6:53:19avoid neonatal respiratory depression.
6:53:21The safest window for administration is
6:53:222 to 4 hours before birth, ideally
6:53:25during active labor, 7 to 8 cm dilation,
6:53:28when contractions are well established.
6:53:31To minimize fetal exposure to the
6:53:33medication, opioids should be given
6:53:35during the peak of a contraction.
6:53:37Meanwhile, distinguishing between true
6:53:39and false labor is vital in labor
6:53:42assessment. True labor is characterized
6:53:43by regular contractions that increase in
6:53:45intensity along with cervical dilation
6:53:48and aacement and contractions that
6:53:50persist despite activity changes. In
6:53:53contrast, false labor involves irregular
6:53:55contractions, no significant cervical
6:53:57changes, and pain that is relieved by
6:53:59rest or hydration.
6:54:01Fetal heart rate, FHR, monitoring plays
6:54:04a crucial role in assessing fetal
6:54:06well-being. The veil chop pneummonic
6:54:08helps interpret FHR changes. Variable
6:54:10decelerations indicate chord
6:54:12compression, requiring maternal
6:54:13repositioning. Early decelerations are
6:54:16caused by head compression and are
6:54:17considered normal, requiring only
6:54:19documentation. Accelerations signify
6:54:22adequate oxygenation and are reassuring.
6:54:25Whereas late decelerations indicate
6:54:27placental insufficiency and necessitate
6:54:30immediate lion interventions, left side
6:54:33repositioning, intravenous fluids,
6:54:35oxygen administration, and notifying the
6:54:37provider. Specific FHR patterns provide
6:54:40additional insights into fetal status.
6:54:42Acceleration, which is a temporary
6:54:44increase in FHR, is a reassuring sign.
6:54:47However, a low fetal heart rate below
6:54:50110 beats per minute requires stopping
6:54:52ptocin and implementing Li
6:54:54interventions, while a high fetal heart
6:54:56rate above 160 beats per minute may
6:54:59indicate infection requiring maternal
6:55:01temperature assessment. Variability in
6:55:03FHR is another key factor. Low baseline
6:55:06variability is concerning and demands
6:55:08lion interventions, whereas high
6:55:10baseline variability is reassuring and
6:55:12should be documented. Decelerations
6:55:15provide further clues to fetal
6:55:16well-being. Early decelerations where
6:55:18FHR dips before or at the beginning of
6:55:20contractions are normal and require only
6:55:23documentation. However, variable
6:55:26decelerations, which indicate cord
6:55:28prolapse, require repositioning and
6:55:30possibly pushing the presenting part off
6:55:32the chord. The most concerning are late
6:55:35decelerations, which occur after the
6:55:36contraction onset and signal fetal
6:55:39distress, requiring immediate lion
6:55:41interventions.
6:55:43Severe fetal distress is particularly
6:55:45evident when late decelerations persist
6:55:48beyond the end of contractions
6:55:49indicating uteroplacental insufficiency
6:55:52and compromised fetal oxygenation. In
6:55:54such cases, oxytocin must be stopped
6:55:57immediately. The client repositioned to
6:55:59the left lateral side. Oxygen
6:56:01administered at 8 to 10 L per minute via
6:56:04a face mask. An introvenous bolus of
6:56:07normal saline or lactated ring is given
6:56:09and the provider notified without delay.
6:56:12A sinosoidal fetal heart rate pattern
6:56:14which appears as a wavelike pattern with
6:56:16no variability and no response to
6:56:18contractions suggests severe fetal
6:56:21anemia, hypoxia or Rh incompatibility.
6:56:25This is an obstetric emergency requiring
6:56:27immediate intervention including
6:56:29emergency delivery or intrauterine
6:56:31resuscitation. Regarding OB medications,
6:56:34pain medication should not be
6:56:36administered if birth is imminent to
6:56:38prevent neonatal respiratory depression.
6:56:41Introvenous pain medications peak within
6:56:4315 to 30 minutes. So their timing is
6:56:45crucial to avoid complications. Lastly,
6:56:48surfactant is administered post birth to
6:56:50neonates with immature lungs via an
6:56:53endotracheal tube ET directly into the
6:56:56lungs ensuring improved respiratory
6:56:58function. Before we move ahead, let me
6:57:00take a quick moment to tell you
6:57:01something that could completely change
6:57:03your enclelex journey. If you're serious
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6:57:13enclelex crash course. This isn't just
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6:58:25description box. Let's continue the
6:58:27video. We're about to dive into the
6:58:29medical surgical enclelex review. This
6:58:32crash course is designed so
6:58:33comprehensively that nothing beyond this
6:58:35will be asked on your exam. So stay
6:58:37focused, stay confident, and make sure
6:58:39you stick with me until the very end.
6:58:41Let's talk about emergency nursing
6:58:43principles and management. Starting with
6:58:45triage in emergency nursing. Triage is
6:58:48the process of prioritizing patient care
6:58:50based on acuity, especially in emergency
6:58:52situations or during mass casualty
6:58:54events. It helps determine who needs
6:58:56immediate attention and who can safely
6:58:58wait. Based on acuity, triage is divided
6:59:01into three main categories. First is the
6:59:04emergent category, which includes
6:59:05life-threatening conditions that require
6:59:07immediate attention. Examples of this
6:59:09include respiratory distress, active
6:59:11chest pain which may suggest a mioardial
6:59:13infarction or heart attack, major
6:59:15trauma, stroke, severe burns, shock, and
6:59:19severe allergic reactions known as
6:59:21anaphilaxis. Second is the urgent
6:59:23category which includes serious
6:59:24conditions but they are not immediately
6:59:26life-threatening. These patients need
6:59:28quick treatment but not necessarily
6:59:30immediate care. Some examples include
6:59:32major fractures, whether open or closed,
6:59:35pain that is uncontrolled, dehydration,
6:59:37high fever accompanied by neurological
6:59:39symptoms, and active bleeding that is
6:59:42not considered life-threatening.
6:59:44Third is the non-urgent category, which
6:59:46includes stable conditions that can wait
6:59:48without any immediate risk. Examples
6:59:51include minor cuts, scrapes, also known
6:59:53as abrasions, sprains, mild burns, sore
6:59:56throat, and infections of the ear. Now
6:59:59in situations involving mass casualties
7:00:02where resources like time, staff or
7:00:04equipment are limited, a tagging system
7:00:06is used. This is called mass casualty
7:00:09triage and it categorizes patients based
7:00:11on their likelihood of survival. Class
7:00:13one, also known as the red tag category,
7:00:16is for immediate cases that are critical
7:00:17and life-threatening.
7:00:19These patients require urgent
7:00:21intervention in order to survive.
7:00:23Examples include severe respiratory
7:00:24distress, tension pumthorax, which is
7:00:26when air gets trapped in the chest,
7:00:28severe burns, major bleeding, also
7:00:30called major hemorrhage, and penetrating
7:00:32injuries to the chest or abdomen. Class
7:00:352, also known as the yellow tag
7:00:37category, includes patients with major
7:00:39injuries, but they are stable enough to
7:00:41wait for treatment if necessary.
7:00:43Examples include open fractures without
7:00:45heavy bleeding, large soft tissue
7:00:48injuries, and burns that cover a
7:00:50moderate area of the body. Class three,
7:00:53also called the green tag category,
7:00:55includes patients with minor injuries,
7:00:57often referred to as the walking
7:00:59wounded. These individuals do not need
7:01:01immediate medical care. Examples include
7:01:03sprains, small cuts, scrapes, and minor
7:01:06burns. Class 4, also known as the black
7:01:08tag category, includes patients who are
7:01:11either deceased or are expected to die
7:01:13due to the severity of their injuries.
7:01:15These individuals have minimal chances
7:01:17of survival, and the focus may shift
7:01:19toward providing comfort care. Examples
7:01:22include massive head trauma with signs
7:01:24of brain herniation, full thickness
7:01:26burns covering more than 90% of the
7:01:28body, and high spinal cord injuries that
7:01:30result in no spontaneous breathing. Now,
7:01:32let's move on to emergency priorities,
7:01:34which are guided by the ABCDE approach.
7:01:38A stands for airway. The first step is
7:01:40to ensure that the airway is open and
7:01:42not obstructed. To do this, we use the
7:01:44head tilt chin lift maneuver. But if a
7:01:46cervical spine injury is suspected, then
7:01:48we use the jaw thrust maneuver instead.
7:01:51We may also need to consider procedures
7:01:53like intubation, suctioning or using
7:01:55airway devices such as an orapharingial
7:01:57airway. B stands for breathing. Here we
7:02:00assess and support ventilation. This
7:02:02involves checking if the patient is
7:02:03receiving enough oxygen. We use tools
7:02:05like pulse oximry or arterial blood
7:02:07gases abbreviated as ABG if necessary.
7:02:10Depending on the situation, we may
7:02:12provide oxygen therapy through devices
7:02:14like a non-rebreather mask, ble positive
7:02:17airway pressure or BiPAP, continuous
7:02:19positive airway pressure or CPAP, or
7:02:22even mechanical ventilation. C stands
7:02:24for circulation. This step is about
7:02:27managing blood flow and blood pressure.
7:02:30We check the patients pulses, measure
7:02:32blood pressure, observe skin color, and
7:02:34test capillary refill time. If the
7:02:37patient is bleeding, we control it by
7:02:39applying direct pressure or using a
7:02:40tourniquet if required. At the same
7:02:42time, we establish intravenous access
7:02:44using large bore intravenous lines for
7:02:46fluid resuscitation. D stands for
7:02:49disability. This refers to checking the
7:02:51patients neurological status. We assess
7:02:54the level of consciousness using the
7:02:55Glasggo coma scale. We also examine the
7:02:57pupils, check body movements, and
7:02:59observe the response to painful stimuli.
7:03:01During this step, we consider possible
7:03:03causes such as lack of oxygen, stroke,
7:03:05or physical trauma. E stands for
7:03:08exposure. This final step is about
7:03:11identifying hidden injuries and
7:03:12preventing hypothermia. We remove any
7:03:14wet clothing, cover the patient with
7:03:16warm blankets, and if needed, provide
7:03:18warmed intravenous fluids. It's also
7:03:20important to check the entire body,
7:03:22including areas not easily seen, such as
7:03:23the back, especially in trauma patients.
7:03:26And that brings us to the end of the key
7:03:27emergency nursing principles covering
7:03:29both triage systems and the critical
7:03:30ABCDE approach to emergency care. Let's
7:03:34begin with the topic of poisoning
7:03:36management. The very first and most
7:03:38important point to remember is do not
7:03:40induce vomiting. The use of syrup of
7:03:43IPAC is no longer recommended and should
7:03:46be avoided.
7:03:48Now moving on to management strategies
7:03:49for poisoning. First, we use activated
7:03:52charcoal which helps absorb ingested
7:03:54toxins. It is most effective when given
7:03:56within 1 hour of ingestion. Uh second,
7:03:58we consider gastric lavage, but only if
7:04:01a potentially lethal dose of poison was
7:04:03ingested and the patient presents within
7:04:051 hour. Third, we may use whole bowel
7:04:08irrigation, which is especially useful
7:04:09in cases where the patient has consumed
7:04:11sustained release or entric coded drugs.
7:04:14Examples include iron, lithium, or in
7:04:16cases involving body packers, people who
7:04:18internally conceal drugs. Fourth, we use
7:04:21antidotes but only if they are
7:04:23applicable to the specific poisoning
7:04:25case. For example, in an acetaminophen
7:04:27overdose, the antidote is n
7:04:29acetylcysteine, also called NAC. In an
7:04:32opioid overdose, the antidote is
7:04:34nlloxxone. In a benzoazipene overdose,
7:04:37the antidote is flumanil. In cases of
7:04:40organo phosphate poisoning, the
7:04:42antidotes are atropene and plladoxim.
7:04:45And don't forget always call the rapid
7:04:47response team if the patient is showing
7:04:49any signs of rapid deterioration. Now
7:04:51let's move on to cardiac emergencies
7:04:53specifically the management of
7:04:54ventricular fibrillation which is
7:04:56abbreviated as VIB and ventricular tacic
7:04:59cardia abbreviated as VTA. Step one is
7:05:02to initiate basic life support or BLS
7:05:06along with cardopulmonary resuscitation
7:05:08commonly known as CPR. The focus should
7:05:10be on delivering highquality chest
7:05:12compressions. Step two, if there is no
7:05:15pulse, proceed with defibrillation. This
7:05:18can be done using an automated external
7:05:20defibrillator or a manual defibrillator.
7:05:23Step three is to establish introvenous
7:05:24access and administer emergency
7:05:26medications. These include epinephrine,
7:05:291 millig given intravenously every 3 to
7:05:325 minutes. Amiodarone with a first dose
7:05:35of 300 milligs given introvenously and a
7:05:38second dose of 150 millig. Other
7:05:41medications like lidocaine, magnesium or
7:05:44pconomide may also be considered
7:05:45depending on the situation. Now let's
7:05:47explore some important pharmacological
7:05:49considerations for emergency medications
7:05:52focusing on adinuric receptors and their
7:05:54functions. There are several types of
7:05:56receptors to understand. Alpha 1
7:05:58receptors are located in the skin,
7:06:00mucous membranes and veins. Their main
7:06:03function is to cause vasoc constriction
7:06:05which increases blood pressure, reduces
7:06:07congestion and helps stop superficial
7:06:10bleeding. Medications that act on alpha
7:06:121 receptors include epinephrine and
7:06:14phenylphrine. Beta 1 receptors are
7:06:16located in the heart. They work to
7:06:18increase heart rate and cardiac output.
7:06:21Examples of medications that act here
7:06:23include dobutamine and dopamine,
7:06:25especially at low doses. Beta 2
7:06:27receptors are found in the lungs and the
7:06:29uterus. They cause broncoilation and
7:06:31relaxation of uterine smooth muscle.
7:06:34Medications acting on these receptors
7:06:35include albuterol and tbutiline.
7:06:38Dopamine receptors are mainly found in
7:06:40the kidneys and the heart. At low doses,
7:06:42dopamine increases renal profusion. At
7:06:45higher doses, it increases blood
7:06:46pressure and heart rate. Now, let's go
7:06:48over a few key medications commonly used
7:06:50in emergencies. Epinephrine acts on
7:06:53alpha 1, beta 1, and beta 2 receptors.
7:06:56Its effects include vasoc constriction
7:06:58which raises blood pressure, increasing
7:07:00heart rate and causing bronco dilation.
7:07:02It is used in cases of anaphilaxis,
7:07:04cardiac arrest and severe asthma. Side
7:07:06effects include hypertensive crisis,
7:07:08abnormal heart rhythms or dysriythmias
7:07:11and chest pain known as angina. Next is
7:07:14tabutamine, a beta 1 agonist. It
7:07:16increases both heart rate and the
7:07:18strength of the heart's contractions. It
7:07:20is used to treat heart failure and
7:07:21cardiogenic shock. However, it may cause
7:07:24side effects like abnormal heart rhythms
7:07:26and rapid heart rate also called
7:07:28tacocardia.
7:07:30Then we have dopamine which has dose
7:07:32dependent effects. At low doses, it
7:07:34causes renal vasoddilation. At moderate
7:07:36doses, it increases heart rate by
7:07:38stimulating beta 1 receptors. At high
7:07:40doses, it causes vasoc constriction by
7:07:42stimulating alpha 1 receptors. It is
7:07:45commonly used in cases of shock and
7:07:47heart failure. Side effects include
7:07:49irregular heart rhythms and chest pain.
7:07:52Let's look at question one. Emergency
7:07:54triage and prioritization.
7:07:56A nurse is working in the emergency
7:07:58department during a mass casualty
7:08:00incident. Four patients arrive at the
7:08:02same time. The question is which patient
7:08:04should receive a red tag, also known as
7:08:06class one, according to triage
7:08:08protocols. Let's go through the options
7:08:10one by one. Option A describes a
7:08:1345-year-old male with an open tibial
7:08:15fracture and controlled bleeding who is
7:08:17reporting severe pain. Option B is a
7:08:2032-year-old female with a penetrating
7:08:22head wound showing agonal breathing and
7:08:24a Glasgow coma scale score of three.
7:08:26Option C is a 60-year-old male with
7:08:28severe chest pain, sweating, also called
7:08:30diapharesis and shortness of breath.
7:08:34Option D is a 25-year-old female who has
7:08:36minor abrasions and a sprained ankle and
7:08:38she is able to walk without any
7:08:40assistance. Now, the correct answer is
7:08:42option C, the 60-year-old male with
7:08:44chest pain, sweating, and shortness of
7:08:46breath. Here's why. This patient is
7:08:48showing signs of a possible mocardial
7:08:50inffection, also called a heart attack.
7:08:52This is a life-threatening emergency and
7:08:54requires immediate intervention, which
7:08:56means he should receive a red tag or
7:08:58class one designation. Option A, the
7:09:01patient with the open fracture and
7:09:03controlled bleeding has a major injury,
7:09:05but it is not immediately
7:09:06life-threatening, so he falls under the
7:09:08yellow tag or class two. Option B, the
7:09:11patient with the penetrating head wound
7:09:12and a Glasgow coma scale of three has
7:09:15minimal chances of survival. That means
7:09:18she should receive a black tag or class
7:09:204. Option D, who has only minor injuries
7:09:22and is able to walk, falls into the
7:09:24green tag group, also called class 3.
7:09:26She can safely wait for treatment. Now,
7:09:29moving on to question two, emergency
7:09:31airway management. A nurse in the
7:09:33emergency department is assessing an
7:09:34unconscious trauma patient who was found
7:09:36unresponsive after a motor vehicle
7:09:38accident. The patient's jaw is clenched
7:09:40and there is concern for a possible
7:09:41cervical spine injury. The question is
7:09:44what is the priority nursing action in
7:09:46this situation? Let's review the
7:09:48options. Option A says to perform the
7:09:50head tilt chin lift maneuver to open the
7:09:52airway. Option B suggests inserting an
7:09:55orapharingial airway to maintain airway
7:09:57patency. Option C recommends using the
7:09:59jaw thrust maneuver to open the airway
7:10:01while keeping the spine stable. Option D
7:10:04suggests preparing for immediate
7:10:05endotracchial intubation with rapid
7:10:07sequence induction. Now the correct
7:10:10answer is option C. Use the jaw thrust
7:10:12maneuver while maintaining spinal
7:10:14precautions. Here's the rationale. When
7:10:16a cervical spine injury is suspected, we
7:10:18must protect the neck and avoid any
7:10:20movements that could cause further harm.
7:10:22That means the head tilt chin lift
7:10:24method is contraindicated and should not
7:10:26be used when to which eliminates option
7:10:29A. The jaw thrust maneuver is the
7:10:31preferred technique in these cases
7:10:32because it helps open the airway without
7:10:35moving the neck.
7:10:37An orapharingial airway as mentioned in
7:10:39option B may be used but only after the
7:10:41airway has already been opened manually.
7:10:43Endotrachial intubation mentioned in
7:10:45option D is necessary if the patient
7:10:47does not start breathing on their own
7:10:49after the airway has been opened. So
7:10:51once again jaw thrust is the correct
7:10:53first action here. Now before we
7:10:55continue let me ask you something
7:10:56important. Do you want to pass the
7:10:59ENCLEX exam, the National Council
7:11:01Lensure Examination in just one week or
7:11:041 month on your very first try? If yes,
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7:12:02enroll right now, you'll get a massive
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7:12:06opportunity. Visit our website now. The
7:12:09link is in the description. Now, let's
7:12:11move on to an important topic,
7:12:13neurologic diagnostic procedures. These
7:12:16tests are essential for evaluating brain
7:12:17function, detecting abnormalities, and
7:12:19guiding medical interventions. Let's
7:12:21begin with the cerebral angiogram. This
7:12:23procedure helps us visualize the blood
7:12:25vessels in the brain. A catheter is
7:12:27inserted either into the femoral artery
7:12:29in the groin or the corateed artery in
7:12:31the neck and then threaded up into the
7:12:33brain. Here are some key points to
7:12:35remember. First, it uses contrast dye.
7:12:38So before the procedure, always check
7:12:40for allergies to iodine or shellfish.
7:12:42Second, evaluate renal function. That
7:12:45means checking blood ura nitrogen
7:12:46abbreviated as BU N and creatinine
7:12:49levels. This is important because
7:12:50impaired kidney function can prevent the
7:12:52body from excreting the contrast die
7:12:54which may lead to toxicity. Also make
7:12:57sure to assess if the patient is
7:12:58pregnant since the contrast dye is
7:13:00harmful to the fetus. It is teratogenic.
7:13:02Now for pre-procedure care the patient
7:13:05should be nothing by mouth for 4 to 6
7:13:07hours before the procedure. In addition,
7:13:09anti-coagulant medications should be
7:13:11held since they increase the risk of
7:13:12bleeding. After the procedure, monitor
7:13:15closely for bleeding at the catheter
7:13:17insertion site. Also, check for distal
7:13:19pulses and circulation in the affected
7:13:21limb to make sure blood flow is
7:13:23adequate. Be alert for signs of hematoma
7:13:26formation or stroke such as weakness on
7:13:28one side, slurred speech, or confusion.
7:13:31Next is the CT scan, also known as
7:13:33computed tomography. This scan uses
7:13:35X-rays and sometimes contrast dye to
7:13:37create detailed images of the brain. Key
7:13:39points include the following. Before
7:13:41administering contrast die, check for
7:13:43iodine or shellfish allergies. Also,
7:13:46evaluate kidney function using bun and
7:13:48creatinine levels. During the scan, the
7:13:50patient must remain still to avoid
7:13:52blurry images. After the scan, encourage
7:13:55increased fluid intake to help flush the
7:13:56contrast die from the body. Now, let's
7:13:59talk about the EEG, which stands for
7:14:01electrophilogram. An EEG is used to
7:14:04detect seizure activity, sleep
7:14:05disorders, and behavior changes by
7:14:07measuring the electrical activity of the
7:14:09brain. Here's what to remember. Before
7:14:11the test, the patient doesn't need to
7:14:13fast, but they should avoid caffeine as
7:14:15it can interfere with brain activity.
7:14:17Also, the patient should wash their hair
7:14:19beforehand. No oils, sprays, or
7:14:22conditioners should be used. Sometimes
7:14:24the test may require sleep deprivation
7:14:25to increase the likelihood of detecting
7:14:27abnormal brain activity. The patient
7:14:29might also be exposed to flashing lights
7:14:31or asked to hyperventilate during the
7:14:33test to stimulate the brain. During the
7:14:35test, the procedure usually takes about
7:14:371 hour and it is noninvasive and
7:14:39completely painless. After the test, the
7:14:42patient can resume normal activities
7:14:44unless instructed otherwise by the
7:14:46healthcare provider. Let's now discuss
7:14:48the Glasgow coma scale. The Glasgow coma
7:14:51scale is used to assess the level of
7:14:53consciousness in patients who have
7:14:54experienced brain injuries. On this
7:14:56scale, the highest possible score is 15,
7:14:58indicating that the patient is fully
7:15:00alert. A score of eight or less
7:15:02indicates severe head injury or coma.
7:15:05The assessment is based on three main
7:15:07components. The first component is
7:15:09eyeopening response, which is scored
7:15:11from 1 to four. A score of four
7:15:13indicates the patients eyes open
7:15:15spontaneously without any prompt. A
7:15:18score of three means the patient opens
7:15:20their eyes only to verbal commands. A
7:15:22score of two means eyes open only in
7:15:24response to pain. A score of one
7:15:26indicates there is no eye opening at
7:15:28all. The second component is verbal
7:15:30response scored from 1 to five. Five
7:15:33indicates the patient speaks coherently
7:15:35and is fully oriented. Four means the
7:15:37patient is confused but still able to
7:15:39converse. Three indicates the use of
7:15:41inappropriate words. Two is given if the
7:15:43patient makes incomprehensible sounds. A
7:15:46score of one indicates no vocal
7:15:47response. The third component is motor
7:15:49response scored from 1 to six. Six means
7:15:52the patient can follow commands fully.
7:15:54Five is given if the patient localizes
7:15:57or moves toward the source of pain. Four
7:15:59indicates the patient withdraws or pulls
7:16:01away from pain. Three is decorticate
7:16:03posturing characterized by arms flexed
7:16:05inward bent toward the core. Two is
7:16:07derebraate posturing where arms are
7:16:09extended and wrists rotated outward. A
7:16:11score of one indicates no motor response
7:16:13at all. Next, let's talk about
7:16:15intraanial pressure monitoring commonly
7:16:17called ICP monitoring. Intraraanial
7:16:20pressure monitoring is essential for
7:16:21patients with a Glasgow coma scale score
7:16:23of eight or less. It measures the
7:16:25pressure inside the skull helping
7:16:26prevent further brain injury. The
7:16:28devices commonly used for intraanial
7:16:30pressure monitoring include
7:16:31intraventricular catheter which is
7:16:33considered the gold standard.
7:16:35Subaractoid screw or bolt epidural or
7:16:38subdural sensors. There are certain
7:16:40signs indicating increased intraraanial
7:16:42pressure that nurses must watch for
7:16:43carefully. Early signs include
7:16:45irritability and restlessness, severe
7:16:47headache, decreased level of
7:16:49consciousness, and abnormalities in
7:16:51pupils such as unequal or sluggish
7:16:53reactions. Late signs include Cheney
7:16:56Stokes respirations, which is an
7:16:57irregular breathing pattern, as well as
7:16:59abnormal body posturing like decorticate
7:17:02or derebbrate positions. The normal
7:17:04range of intraanial pressure is between
7:17:0610 to 15 millime of mercury. Now, let's
7:17:10move to the next topic. Lumbar puncture
7:17:12also called a spinal tap. A lumbar
7:17:15puncture is performed to collect
7:17:16cerebral spinal fluid. It helps diagnose
7:17:18conditions such as infections like
7:17:20menitis or syphilis, multiple sclerosis
7:17:23or to check for increased intraanial
7:17:25pressure. There are key points for
7:17:27nurses and patients to remember about
7:17:29this procedure. Before the lumbar
7:17:31puncture,
7:17:33the patient should empty their bladder.
7:17:34Positioning is important. The patient
7:17:36should either lie curled in a fetal
7:17:38position, sometimes called the
7:17:39cannonball position, or sit upright,
7:17:41leaning forward. Local anesthetic is
7:17:43applied to the puncture site to minimize
7:17:45discomfort before inserting the needle.
7:17:48After the procedure, certain steps must
7:17:49be taken. The patient should lay flat
7:17:52for several hours to prevent cerebral
7:17:53spinal fluid leakage and the occurrence
7:17:55of a spinal headache. It is essential to
7:17:58monitor the puncture site carefully for
7:18:00any bleeding or signs of infection.
7:18:02Increasing fluid intake is encouraged to
7:18:04help the body replenish cerebral spinal
7:18:06fluid. If a spinal headache develops
7:18:08from fluid leakage, a blood patch
7:18:10procedure may be required to relieve
7:18:12symptoms. Moving forward, let's discuss
7:18:15magnetic resonance imaging. An MRI
7:18:17provides detailed images of the brain
7:18:19using magnetic fields and sometimes it
7:18:21involves injecting a contrast die. Key
7:18:24points nurses should ensure before this
7:18:27test include checking if the patient has
7:18:29allergies, particularly to shellfish or
7:18:31iodine, if contrast dye will be used.
7:18:34Removing all metal objects from the
7:18:36patient such as jewelry, hearing aids
7:18:38and dentures. Verifying if the patient
7:18:40has implants like pacemakers, orthopedic
7:18:42joints, artificial heart valves,
7:18:44intrauterine devices, or aneurysm clips
7:18:46as these could interfere with the test.
7:18:48Assessing the patient for claustrophobia
7:18:50as sedation might be required. providing
7:18:52earplugs as the MRI machine is quite
7:18:54loud. Finally, let's cover the posetron
7:18:57emission tomography scan. A PET scan is
7:18:59a nuclear medicine imaging test that
7:19:01helps detect tumor activity and assess
7:19:03brain function by measuring glucose
7:19:05metabolism in the brain. Important
7:19:08points for patients undergoing a PET
7:19:09scan include avoiding caffeine, alcohol,
7:19:12and tobacco before the procedure as
7:19:15these substances can interfere with the
7:19:17results. The patient may also need to
7:19:19fast before the scan. During the
7:19:21procedure, a radioactive tracer is
7:19:23injected to highlight areas of high
7:19:24metabolic activity such as tumors or
7:19:27abnormal brain function. Now, let's
7:19:30discuss X-rays. X-rays are sometimes
7:19:32used in neurological evaluations to
7:19:34identify fractures, abnormal curvatures,
7:19:35or dislocations that could potentially
7:19:37damage the nervous system. Specifically,
7:19:40X-rays can detect skull or spinal
7:19:42fractures, cervical spine injuries, and
7:19:44vertebral abnormalities. Let's practice
7:19:46an ENLEX question related to
7:19:48neurological assessments. A nurse is
7:19:50caring for a patient who just underwent
7:19:52a lumbar puncture. Which of the
7:19:55following nursing interventions is the
7:19:56priority? Option A, encourage the
7:19:58patient to ambulate as soon as possible.
7:20:01Option B, place the patient in a
7:20:03semifoul's position. Option C, monitor
7:20:06the puncture site for leakage and have
7:20:08the patient lie flat. Option D, restrict
7:20:11fluid intake to prevent cerebral edema.
7:20:14The correct answer is option C, which is
7:20:16to monitor the puncture site for leakage
7:20:18and have the patient lie flat. Lying
7:20:21flat after a lumbar puncture reduces the
7:20:22risk of cerebral spinal fluid leakage,
7:20:24which could lead to severe spinal
7:20:26headaches. It is also important for the
7:20:28nurse to closely monitor the puncture
7:20:30site for signs of leakage or other
7:20:32complications.
7:20:34Let's briefly discuss why the other
7:20:36options are incorrect. Option A,
7:20:38encouraging the patient to ambulate
7:20:40early is incorrect because moving around
7:20:41too soon increases the risk of cerebral
7:20:44spinal fluid leakage and spinal
7:20:46headaches. Option B, placing the patient
7:20:49in a semifers's position is also
7:20:51incorrect because patients must remain
7:20:53flat for several hours to prevent
7:20:55postlumbar puncture headaches. Option D,
7:20:58restricting fluid intake to prevent
7:20:59cerebral edema is incorrect because
7:21:01after a lumbar puncture, fluids should
7:21:04actually be increased to replenish
7:21:05cerebral spinal fluid and help prevent
7:21:07headaches related to dehydration. Let's
7:21:10try another practice question. A nurse
7:21:12is preparing a patient for a magnetic
7:21:14resonance imaging scan, also known as an
7:21:16MRI scan. Which of the following
7:21:19assessments is the priority before the
7:21:21procedure? Option A, assess the patient
7:21:23for a history of claustrophobia. Option
7:21:26B, check for metal implants such as
7:21:28pacemakers or aneurysm clips. Option C,
7:21:31instruct the patient to remove all
7:21:33jewelry and metal objects. Option D,
7:21:36determine if the patient has an allergy
7:21:38to iodine or shellfish. The correct
7:21:40answer is option B, to check for metal
7:21:43implants such as pacemakers or aneurysm
7:21:45clips. An MRI uses powerful magnetic
7:21:47fields that can interact dangerously
7:21:49with metal implants, potentially causing
7:21:51life-threatening complications.
7:21:53Therefore, this assessment is the
7:21:55highest priority. Why are the other
7:21:57options incorrect? Option A, assessing
7:22:00the patient for claustrophobia is
7:22:01important but not the first priority. If
7:22:04severe claustrophobia is present,
7:22:05sedation may be considered. Option C,
7:22:08instructing the patient to remove
7:22:10jewelry and other metal objects is
7:22:11necessary, but implanted metal devices
7:22:14pose a greater risk than removable
7:22:16objects. Option D, checking for iodine
7:22:18or shellfish allergies is incorrect
7:22:20because MRI contrast agents do not
7:22:23contain iodine. Allergy concerns to
7:22:25iodine or shellfish pertain more to CT
7:22:28scans. Next, let's move on to the
7:22:30important topic of pain management, an
7:22:32essential concept in patient care. Pain
7:22:35can be categorized based on how long it
7:22:37lasts, where it originates, and what
7:22:39mechanism underlies it. Understanding
7:22:41these classifications helps nurses
7:22:43manage pain effectively. There are two
7:22:45main types of pain based on duration.
7:22:47The first type is acute pain which is
7:22:50temporary, protective and resolves as
7:22:52the tissue heals. Acute pain commonly
7:22:55occurs after surgery, injuries or
7:22:56inflammation. It often feels sharp or
7:22:59intense but improves as the underlying
7:23:01cause heals. The second type is chronic
7:23:04pain which persists beyond 6 months.
7:23:06Chronic pain can be continuous or
7:23:08intermittent and is often associated
7:23:09with psychological effects such as
7:23:11depression, anxiety, and fatigue.
7:23:14Chronic pain typically reduces a
7:23:16patients ability to function normally
7:23:18and significantly impacts quality of
7:23:20life. Pain is also classified based on
7:23:23the underlying cause. First we have no
7:23:26susceptive pain which is caused by
7:23:28tissue damage or inflammation. This type
7:23:30of pain typically feels throbbing,
7:23:32aching and localized. No susceptive pain
7:23:35can be further divided into sematic pain
7:23:38which originates from bones, joints,
7:23:40muscles, skin and connective tissues.
7:23:43Visceral pain originating from internal
7:23:45organs such as the stomach or
7:23:47intestines. This pain is often diffuse,
7:23:49deep cramping and sometimes referred to
7:23:51other parts of the body. Cutaneous pain
7:23:54arising from the skin or subcutaneous
7:23:56tissue and often described as sharp or
7:23:59burning. Another category is neuropathic
7:24:02pain which results from nerve damage or
7:24:04dysfunction. Neuropathic pain typically
7:24:06presents as a burning sensation,
7:24:08shooting pain, electricike feelings, or
7:24:10tingling sensations described as pins
7:24:12and needles. Common examples include
7:24:14diabetic neuropathy, which is nerve
7:24:16damage from prolonged high blood sugar,
7:24:18and phantom limb pain experienced in
7:24:20limbs that have been amputated.
7:24:22Treatments for neuropathic pain may
7:24:24include muscle relaxants,
7:24:26anti-depressants such as amitryptaline
7:24:28or duloxitine, anti-convulsants like
7:24:30gabapentin or praabalin or
7:24:33antis-pspasmotic medications. Finally,
7:24:35let's discuss how nurses systematically
7:24:37assess pain using the pqrst method. P
7:24:41stands for provocation or paliation.
7:24:43What triggers or relieves the pain? Q
7:24:46stands for quality. Can the patient
7:24:47describe the type of pain? Is it dull,
7:24:50sharp, throbbing, or burning? R stands
7:24:52for radiation. Does the pain spread to
7:24:54other areas of the body? S stands for
7:24:56severity. Ask the patient to rate the
7:24:58pain on a scale from 1 to 10. T stands
7:25:01for timing. When did the pain start, and
7:25:04how long does it usually last? Other
7:25:06important factors to assess include the
7:25:08setting in which pain began, what the
7:25:09patient was doing, when the pain
7:25:11started, and how the pain impacts their
7:25:13daily life. It's also crucial to
7:25:15identify aggravating factors which are
7:25:17things that make the pain worse and
7:25:19relieving factors which are actions or
7:25:21treatments that ease the pain. Now let's
7:25:23discuss pain management approaches which
7:25:25are essential for effective nursing
7:25:27care. Pain can be managed using two main
7:25:29approaches. Non-farmacological methods
7:25:31which do not involve medication and
7:25:33pharmarmacological methods which use
7:25:35medicines to relieve pain. Let's first
7:25:38understand the non-farmacological
7:25:40methods. One effective method is
7:25:41physical therapy which improves the
7:25:43patients movement and reduces pain.
7:25:45Another useful approach is
7:25:47transcutaneous electrical nerve
7:25:49stimulation known as TENS.
7:25:52This involves using small electrical
7:25:53impulses to help reduce the sensation of
7:25:55pain. We also commonly use heat or cold
7:25:59therapy. Heat therapy relaxes muscles
7:26:01and provides relief while cold therapy
7:26:03reduces swelling and inflammation.
7:26:05Additionally, treatments such as
7:26:07acupuncture and therapeutic massage
7:26:09helped by stimulating circulation and
7:26:11relieving muscle tension to address
7:26:13stress related pain. Relaxation
7:26:15techniques and guided imagery are
7:26:17beneficial. These methods promote mental
7:26:19relaxation which often decreases the
7:26:21patients perception of pain. Now let's
7:26:23move to pharmacological management where
7:26:25medications are prescribed based on the
7:26:27patients reported pain severity. For
7:26:29accurate assessment, we use a pain
7:26:31severity scale ranging from zero,
7:26:33indicating no pain up to 10, which
7:26:36represents the worst possible pain. If
7:26:38the pain is mild, rated between 1 and
7:26:40three out of 10. Common medications
7:26:42include non-steroidal anti-inflammatory
7:26:45drugs, also known as NSAIDs and
7:26:48acetaminophen. When pain is moderate,
7:26:50rated between four and 6 out of 10, we
7:26:53use weak opioids like traumdol or
7:26:54lowdose oxycodone combined with NSAIDs.
7:26:58For severe pain rated 7 to 10 out of 10,
7:27:00strong opioids such as morphine or
7:27:02fentinyl are necessary. Let's understand
7:27:05non-steroidal anti-inflammatory drugs or
7:27:07NSAIDs in more detail. Examples include
7:27:11ibuprofen, neproxin, mlloxyam, celoxib,
7:27:15aspirin, dicloanac, and indomethasin.
7:27:19While effective, these medications may
7:27:21cause side effects like gastric
7:27:23irritation, gastrointestinal bleeding,
7:27:25and increased risk of ulcers.
7:27:27Specifically, aspirin can cause unique
7:27:29side effects like tonitis, which is a
7:27:31ringing sound in the ears, vertigo or
7:27:33dizziness, and decreased hearing. These
7:27:36symptoms indicate salicellate toxicity.
7:27:39Aspirin should always be avoided in
7:27:41children because of the risk of raised
7:27:43syndrome. It's also important to monitor
7:27:45bleeding times carefully if a patient is
7:27:47taking aspirin along with anti-coagulant
7:27:49medications. Moving to acetaminophen,
7:27:51commonly known as Tylenol, it's mainly
7:27:53used to manage mild pain and fever.
7:27:55However, precautions must be taken. The
7:27:58maximum daily dose should never exceed 4
7:28:00grams per day due to the risk of liver
7:28:02damage known medically as hepattoxicity.
7:28:05Also, acetaminophen should not be given
7:28:07if the patient is already taking
7:28:09medications like Vicodin or Percoet
7:28:12because these drugs already contain
7:28:13acetaminophen.
7:28:15Next are opioids. Medications frequently
7:28:17prescribed for moderate to severe pain.
7:28:19Examples of opioids include morphine,
7:28:22hydromemorphone known by its brand name
7:28:24dilotted, fentinyl, oxycodone or
7:28:26percoet, hydrocodone or vicodin and
7:28:29tremodol. Opioids are commonly used for
7:28:31managing postsurgical pain, cancer
7:28:33related pain and pain during paliotative
7:28:36or end of life care. Fentinyl in
7:28:38particular is often preferred for cancer
7:28:40pain and end of life comfort due to its
7:28:42strong effectiveness and availability as
7:28:43a transdermal skin patch. Opioids have
7:28:46several important side effects and
7:28:48considerations. Constipation is very
7:28:50common and is managed by stool softeners
7:28:52such as docusate and increasing dietary
7:28:54fiber. Orthostatic hypotension or
7:28:57dizziness upon standing may occur. So
7:28:59patients should change position slowly.
7:29:02Another issue can be urinary retention.
7:29:04So urine output needs monitoring
7:29:06sometimes requiring catheterization.
7:29:08Nausea and vomiting might also occur and
7:29:10these are managed effectively with
7:29:12anti-imetic medications such asron.
7:29:16Additionally, opioids may cause
7:29:17sedation. So continuous monitoring of
7:29:20mental status is necessary. The most
7:29:22serious opioid side effect is
7:29:23respiratory depression where breathing
7:29:25becomes dangerously slow. Nurses should
7:29:28carefully monitor respiratory rates
7:29:29especially when opioids are given
7:29:31intravenously to quickly reverse
7:29:33respiratory depression caused by
7:29:35opioids. An opioid antagonist known as
7:29:38nlloxxone or narcan is administered if
7:29:40the respiratory rate falls below eight
7:29:42breaths per minute. After giving the
7:29:45lockxone, always monitor the patient
7:29:46closely for signs of opioid withdrawal.
7:29:49Here are some key takeaways for the
7:29:50anklex exam to remember clearly. Always
7:29:53remember that pain is a subjective,
7:29:56meaning the patients self-reported pain
7:29:58is the most accurate measure. For a
7:30:01thorough pain assessment, we use the
7:30:02PQRST method to fully understand the
7:30:06patients pain experience. Patients
7:30:08taking NSAIDs must be educated about the
7:30:10risk of gastrointestinal irritation and
7:30:12bleeding. So advise them to take these
7:30:14medications with food. Acetaminophen
7:30:17carries a risk of liver failure or
7:30:18hpatotoxicity.
7:30:20So monitor for jaundice and ensure
7:30:22patients avoid alcohol consumption. With
7:30:25opioids the risk of respiratory
7:30:26depression is significant. So always
7:30:28have nlloxxone readily available.
7:30:31Remember constipation is the most common
7:30:33opioid side effect making hydration and
7:30:36increased fiber intake essential.
7:30:38Lastly, chronic pain typically requires
7:30:41a multimodal management approach,
7:30:43combining medication and non-drug
7:30:44therapies for the most effective pain
7:30:46relief. Now, let's review two quick
7:30:49enclelex style questions to reinforce
7:30:51understanding. A nurse is assessing a
7:30:53patient's pain using the PQRST method.
7:30:56The patient reports a burning shooting
7:30:58pain that radiates down the leg. Based
7:31:00on this description, which type of pain
7:31:02is the patient experiencing? A somatic
7:31:05pain. B. Visceral pain. C. Neuropathic
7:31:08pain. D. No susceptive pain. The correct
7:31:12answer is C. Neuropathic pain. This type
7:31:14of pain results from nerve damage or
7:31:16dysfunction and typically feels burning,
7:31:18shooting, or like pins and needles.
7:31:20Question number two. A patient with
7:31:22moderate pain rated 5 out of 10 is
7:31:24prescribed traumodol. The nurse should
7:31:26educate the patient on which potential
7:31:28side effect associated with this
7:31:30medication? A. Respiratory depression.
7:31:33B. Constipation. C. Hpatotoxicity.
7:31:36D. Salicellate toxicity. The correct
7:31:39answer is B. Constipation. Opioids like
7:31:42traumadol commonly cause constipation
7:31:44due to their effects on the
7:31:45gastrointestinal tract. Patients should
7:31:47increase fluid and fiber intake and
7:31:49stool softeners may be recommended. Hey
7:31:52future nurses, if you want to pass the
7:31:54ENCLEX in one try, we've got the
7:31:56ultimate shortcut for you. Our Anclelex
7:31:58review crash course has a 99% passing
7:32:01rate and more than 5,000 nurses have
7:32:03already passed using it. Now it's your
7:32:05turn. Here's what's inside the course.
7:32:08100hour animated crash course, ideal for
7:32:11those with very little time to study.
7:32:13300 hour comprehensive lectures covering
7:32:15300 must know Anklex topics. 5,000 real
7:32:19anklex questions. Learn from past exams.
7:32:2115 full-length practice tests including
7:32:23CAT simulations. exclusive ebook and
7:32:26one-year access so you can study
7:32:28whenever you want. Limited spots left.
7:32:31Enroll now and get 70% off, but only for
7:32:33a short time. Click the link in the
7:32:35description and get started today. Let's
7:32:37now discuss menitis and inflammation of
7:32:39the meningas, the protective membranes
7:32:41covering both the brain and spinal cord.
7:32:43Menitis can be either viral or
7:32:45bacterial. Viral menitis, also known as
7:32:49menitis, is more common and typically
7:32:51self-limiting, meaning it usually
7:32:52resolves without specific treatment. In
7:32:56contrast, bacterial menitis is severe,
7:32:58contagious, and potentially fatal,
7:33:00requiring urgent antibiotic therapy to
7:33:02prevent serious complications such as
7:33:04brain damage, hearing loss, or death.
7:33:07Vaccinations play a key role in
7:33:09preventing menitis. The hip vaccine
7:33:11protects against hemophilus influenza
7:33:13type B, a common bacterial cause of
7:33:15menitis. The maningoakal vaccine is
7:33:18recommended for adolescence and
7:33:19individuals living in crowded conditions
7:33:21such as college dormitories or military
7:33:23barracks. Numoccoal vaccines are
7:33:25recommended for infants, elderly
7:33:27individuals and those who are immuno
7:33:30compromised. Typical signs and symptoms
7:33:32include the classic triad, severe
7:33:34headache, stiff neck, neutral rigidity,
7:33:37and sensitivity to light, phototohobia.
7:33:41Other systemic signs include fever,
7:33:43chills, nausea, vomiting, rapid
7:33:45heartbeat, teocardia, and altered mental
7:33:48status, confusion, drowsiness,
7:33:50irritability.
7:33:51Neurological symptoms can include
7:33:53seizures, increased intraraanial
7:33:54pressure, ICP, and positive Kernig and
7:33:57Brzinski signs. Kernig's sign refers to
7:34:00the inability to extend the knee when
7:34:02the hip is flexed at 90° and Brzinski
7:34:04sign involves involuntary flexion of the
7:34:06hips and knees when the neck is flexed.
7:34:09Skin findings specific to meningo coakal
7:34:11menitis can include a red macular rash
7:34:14progressing to propura or petici
7:34:16indicating disseminated intravascular
7:34:18coagulation. Diagnosis involves cerebral
7:34:21spinal fluid analysis through lumbar
7:34:23puncture. Viral menitis presents with
7:34:26clear cerebral spinal fluid, normal or
7:34:28slightly elevated white blood cells,
7:34:30normal or mildly elevated protein and
7:34:33normal glucose levels. Bacterial menitis
7:34:36shows cloudy cerebrros spinal fluid,
7:34:38significantly increased white blood
7:34:39cells and protein and decreased glucose
7:34:42due to bacterial consumption.
7:34:44Additionally, bacterial menitis
7:34:46typically demonstrates elevated opening
7:34:47pressure caused by increased ICP.
7:34:50Nursing interventions include initiating
7:34:52droplet precautions for bacterial
7:34:54menitis until 24 hours after starting
7:34:56antibiotics, then shifting to standard
7:34:59precautions. Monitoring for increased
7:35:01ICP is crucial. Nurses should keep the
7:35:03head of the bed elevated at 30°.
7:35:05Discourage coughing, sneezing, or
7:35:07straining, and implement seizure
7:35:09precautions, padded side rails, oxygen,
7:35:11and suction equipment at bedside. A
7:35:14quiet, dimly lit room helps minimize
7:35:16photohobia related discomfort. Hydration
7:35:18is important but monitoring for the
7:35:20syndrome of inappropriate antidiuretic
7:35:22hormone secretion SADH is also essential
7:35:26as it can lead to fluid retention,
7:35:27diluted blood, concentrated urine and
7:35:29hyponetriia resulting in confusion,
7:35:32decreased urine output, muscle weakness
7:35:34and seizures.
7:35:36Medications typically include
7:35:37broadspectrum antibiotics such as sept
7:35:39trioxone and vancomy until specific
7:35:42bacteria are identified. Corticosteroids
7:35:45like dexamethasone may be used to reduce
7:35:47inflammation and prevent neurological
7:35:49complications. Antibiotics like
7:35:51acetaminophen manage fever. Analesics,
7:35:53opioids or nsides control pain. And
7:35:56anti-seizure medications phenitoin or
7:35:59levitraetum manage seizures if they
7:36:01occur. Complications include increased
7:36:03intraanial pressure potentially causing
7:36:05brain herniation, septic emblei
7:36:07traveling to other organs leading to
7:36:09stroke or organ failure and SIADH. Eh
7:36:13key points for the enclelex include
7:36:15recognizing bacterial menitis as a
7:36:18medical emergency requiring immediate
7:36:20antibiotic therapy understanding viral
7:36:22menitis is self-limiting with supportive
7:36:25care following droplet precautions for
7:36:2724 hours after antibiotics start closely
7:36:29monitoring increased ICP and
7:36:32distinguishing between viral and
7:36:34bacterial menitis through lumbar
7:36:36puncture findings. Now shifting focus to
7:36:38seizures. These are neurological
7:36:40conditions characterized by sudden
7:36:42uncontrolled electrical activity in the
7:36:44brain resulting in altered
7:36:45consciousness, motor and sensory
7:36:47disturbances. Epilepsy is a chronic
7:36:50disorder involving recurrent seizures
7:36:51due to abnormal brain electrical
7:36:53activity. Seizures can have various
7:36:55causes such as fever especially febreal
7:36:58seizures in children under two genetic
7:37:00predisposition, head trauma, cerebral
7:37:02edema, brain swelling, menitis or
7:37:04encphilitis, electrolyte imbalances like
7:37:07hyponetriia, hypocalcemia,
7:37:09hypomagnesmia, hypoglycemia, hypoxia,
7:37:12toxic exposures, lead poisoning, carbon
7:37:14monoxide, drugs, alcohol, brain tumors
7:37:17or structural abnormalities and
7:37:19withdrawal from drugs or alcohol.
7:37:20Trigger factors include emotional
7:37:22stress, fatigue, excessive caffeine or
7:37:24stimulant use, flashing lights or visual
7:37:27stimuli, photosensitive seizures, and
7:37:29hyperventilation.
7:37:30Seizures are classified into generalized
7:37:33and partial focal. Generalized seizures
7:37:36involve both brain hemispheres and
7:37:38include tonicclonic grand mal seizures
7:37:41absence petit mal seizures common in
7:37:44children myioonic seizures causing brief
7:37:46muscle jerks and atonic or drop seizures
7:37:48leading to sudden falls. Partial
7:37:50seizures involve one hemisphere. Simple
7:37:53partial seizures do not cause loss of
7:37:55consciousness, but can result in
7:37:57twitching or sensory changes. While
7:37:59complex partial seizures impair
7:38:01awareness, cause repetitive movements
7:38:03like lip smacking, and may involve
7:38:05confusion or aura. Nursing interventions
7:38:08during a seizure include ensuring
7:38:10patient safety by gently lowering the
7:38:12patient to the ground, turning them onto
7:38:14their side to prevent aspiration, moving
7:38:16away nearby objects, and loosening
7:38:19restrictive clothing. Nurses must avoid
7:38:22restraining the patient or placing
7:38:23objects into their mouth. Post seizure
7:38:26care involves documenting seizure
7:38:28details onset duration symptoms,
7:38:30monitoring vital signs, reorienting the
7:38:32patient, maintaining a sidelineing
7:38:34position until fully conscious, and
7:38:36implementing seizure precautions,
7:38:38including padded bed rails, and
7:38:40availability of oxygen and suction
7:38:42equipment. Medication management
7:38:43includes anti-epileptic drugs such as
7:38:45phenotin, carbomazipine, valproic acid,
7:38:48levitum, and lamatrene. For phenotin
7:38:52specifically, monitoring serum levels,
7:38:54practicing good oral hygiene to prevent
7:38:55gingial hyperplasia, and noting its
7:38:58interaction with oral contraceptives and
7:39:00warrin are important. Advanced
7:39:02treatments include veagal nerve
7:39:04stimulation where an implanted device
7:39:06controls seizures avoiding MRI and
7:39:09microwaves and surgical removal of
7:39:11epileptic focus for drugresistant
7:39:12seizures such as temporal lobectomy or
7:39:15corpus calistomy.
7:39:17Now let's discuss status epilepticus
7:39:19which is a medical emergency. Status
7:39:21epilepticus is defined as a seizure
7:39:23lasting longer than 5 minutes or
7:39:25multiple seizures occurring backto back
7:39:28without the patient regaining
7:39:29consciousness between episodes. In
7:39:32managing status epilepticus, the first
7:39:33step is to protect the patient's airway
7:39:35and administer oxygen immediately. Next,
7:39:38establish introvenous access quickly as
7:39:41rapid medication administration is
7:39:42crucial. Continuous monitoring of the
7:39:45heart using electroc cardiography also
7:39:47called EKG as well as pulse occimmetry
7:39:50to measure oxygen levels should also be
7:39:52done throughout the episode. When it
7:39:54comes to medications for treating status
7:39:56epilepticus, bzzoazipines such as
7:39:58laorazzipam commonly known as Adavon or
7:40:01dazopam known as Valium are typically
7:40:04the first line treatments. For
7:40:06longerterm control medications like
7:40:07phenotin, dantin or phosphenitoin cabix
7:40:11are used. Let's review two Enclelex
7:40:13style practice questions to understand
7:40:15this topic better. Question one, a nurse
7:40:18is caring for a patient experiencing a
7:40:19tonic clonic seizure. Which intervention
7:40:22should be the nurse's priority? A,
7:40:25insert a tongue blade to prevent the
7:40:26patient from biting their tongue? B,
7:40:28restrain the patient to prevent injury?
7:40:31C, turn the patient onto their side. D,
7:40:34elevate the head of the bed to 90°. The
7:40:36correct answer is option C, turn the
7:40:38patient onto their side. The rationale
7:40:40behind this answer is that turning the
7:40:42patient onto their side helps prevent
7:40:44aspiration and maintains an open airway.
7:40:47Using a tongue blade or restraining the
7:40:49patient can cause injury and elevating
7:40:51the head of the bed is not appropriate
7:40:53during an active seizure. Question two.
7:40:57A patient with epilepsy is prescribed
7:40:59phenotin also known as dantin. Which
7:41:02statement by the patient indicates the
7:41:03need for further teaching? A. I will
7:41:07maintain good oral hygiene to prevent
7:41:08gum problems. B. I need to have my blood
7:41:11levels checked regularly. C. This
7:41:14medication may decrease the
7:41:16effectiveness of my birth control pills.
7:41:18D. I can stop taking the medication once
7:41:21my seizures stop. The correct answer is
7:41:23option D. I can stop taking the
7:41:26medication once my seizures stop. The
7:41:29rationale for this answer is that
7:41:30patients should never abruptly stop
7:41:32taking anti-epileptic medications
7:41:34because doing so may cause seizures to
7:41:36recur or lead to status epilepticus. The
7:41:40other statements demonstrate correct
7:41:41understanding about the use of
7:41:42phenitoin. Next we will discuss
7:41:45Parkinson's disease. Parkinson's disease
7:41:47is a progressive neurodeenerative
7:41:49disorder that affects motor function. It
7:41:52happens due to an imbalance between
7:41:53dopamine and acetylcholine.
7:41:56In Parkinson's disease, dopamine levels
7:41:58become too low because of degeneration
7:42:00in a brain region called the substantia
7:42:02negra. This reduction of dopamine leads
7:42:04to excess stimulation by acetylcholine
7:42:07of the basil ganglia which is
7:42:09responsible for controlling movement.
7:42:11The key symptoms of Parkinson's disease
7:42:13include tremors, specifically a pill
7:42:15rolling tremor, which is more noticeable
7:42:17at rest and decreases during movement.
7:42:19Muscle rigidity, often described as cog
7:42:22wheel rigidity, causing stiffness and
7:42:25resistance when moving. Bradicinesia or
7:42:28slowness of movement. Postural
7:42:30instability resulting in poor balance
7:42:32and increased risk of falls. Shuffling
7:42:35gate known as fascinating gate
7:42:37characterized by short slow steps with a
7:42:39stooped posture. A mask-like facial
7:42:42expression due to reduced facial
7:42:44movements caused by muscle rigidity.
7:42:46dysphasia and difficulty chewing which
7:42:48increases the risk of aspiration
7:42:50pneumonia due to swallowing
7:42:51difficulties, mood swings and cognitive
7:42:53impairment which can progress to
7:42:55dementia in advanced stages. There is no
7:42:57definitive diagnostic test for
7:42:59Parkinson's disease. It is usually
7:43:01diagnosed clinically based on symptoms
7:43:03and the patients response to dopamine
7:43:05therapy. Imaging tests such as magnetic
7:43:07resonance imaging or computed tomography
7:43:09scans may be used to rule out other
7:43:11conditions. Important nursing
7:43:13interventions for patients with
7:43:15Parkinson's disease include monitoring,
7:43:17swallowing ability closely, and having
7:43:19suction equipment readily available to
7:43:21prevent aspiration,
7:43:23encouraging a diet with high calorie
7:43:24nutrient-dense foods, and thickening
7:43:27liquids if swallowing difficulty occurs,
7:43:29allowing extra time for meals with
7:43:31smaller and more frequent portions.
7:43:34encouraging range of motion exercises
7:43:36abbreviated as ROM and regular
7:43:38ambulation to reduce stiffness,
7:43:41suggesting gentle activities like yoga
7:43:43and tai chichi to improve balance and
7:43:45flexibility. speaking slowly, clearly,
7:43:47and using alternate methods of
7:43:49communication if the patient has speech
7:43:51difficulties. Implementing fall
7:43:53precautions such as using assistive
7:43:55devices like a walker or cane.
7:43:57Encouraging slow walking and avoiding
7:43:59multitasking during movement, removing
7:44:02rugs, clutter, and installing grab bars
7:44:04at home. Medication management is
7:44:06essential for Parkinson's disease. Key
7:44:08medications include levodopa carbidopa
7:44:12known as cyomet, which increases
7:44:13dopamine levels. This medication is best
7:44:16absorbed on an empty stomach and protein
7:44:18intake should be moderate because too
7:44:20much protein can decrease its
7:44:22effectiveness. Anticolonergic
7:44:24medications like benstrapine and
7:44:26trihexophenidil help reduce tremors by
7:44:28balancing acetylcholine. However, these
7:44:31should be used cautiously in elderly
7:44:33patients due to risks of confusion,
7:44:35urinary retention and glaucoma.
7:44:37Amantine, an antiviral medication that
7:44:39helps increase dopamine release. MAB
7:44:42inhibitors such as sleuline and
7:44:44rosagoline prevent dopamine breakdown.
7:44:46Patients should avoid foods rich in
7:44:48tyramine like cheese and wine to prevent
7:44:50hypertensive crisis. Potential
7:44:52complications of Parkinson's disease
7:44:54include aspiration pneumonia which can
7:44:57be prevented by eating upright and
7:44:58having suction ready falls and fractures
7:45:01preventable by using assistive devices
7:45:02and removing hazards at home. Depression
7:45:05and cognitive decline which may benefit
7:45:07from support groups and cognitive
7:45:09therapy. To summarize, the key enclelex
7:45:12nursing priorities for Parkinson's
7:45:13disease include monitoring swallowing
7:45:15ability, and thickening liquids if
7:45:17needed, having suction equipment ready
7:45:19at the bedside, encouraging exercises
7:45:22and range of motion activities to
7:45:23prevent stiffness, teaching fall
7:45:25prevention strategies such as wearing
7:45:27non-slip shoes, and using assistive
7:45:29devices, educating the patient about
7:45:31proper medication timing and dietary
7:45:33restrictions, particularly regarding
7:45:35levodopa and protein intake. What do all
7:45:38successful ENCLEX passers have in
7:45:40common? A solid study plan. Our Enclelex
7:45:44review crash course has helped 5,000
7:45:46plus nurses pass in just one try with a
7:45:4999% success rate. And you can be next.
7:45:53Here's your winning formula for success.
7:45:55100hour animated crash course for those
7:45:58who need to pass in just one week. 300
7:46:02hour in-depth lectures covering the most
7:46:04high yield anlex topics. 5,000 real
7:46:08Anklex questions. Get used to the actual
7:46:10exam format.
7:46:1215 fulllength practice tests plus CAT
7:46:14simulations dash. Train like a pro.
7:46:17Exclusive ANCLEX ebook plus one-year
7:46:19access. Study smarter, not harder. This
7:46:22is your chance. Enroll now and grab 70%
7:46:24off.
7:46:26Click the link in the description and
7:46:28start your enclelex journey today. Now
7:46:30we will discuss Alzheimer's disease,
7:46:32also known as AD. It is a progressive
7:46:34and irreversible neurodeenerative
7:46:36disorder that affects memory, cognition,
7:46:39and behavior. Alzheimer's disease
7:46:41primarily occurs after the age of 65 and
7:46:44it is the most common cause of dementia.
7:46:46Several risk factors increase the
7:46:48chances of developing Alzheimer's
7:46:50disease. The primary risk factor is
7:46:52advanced age. Other risk factors include
7:46:54genetic predisposition, particularly
7:46:56involving the APOE gene, a history of
7:46:59head trauma or previous traumatic brain
7:47:01injury, exposure to toxic metals or
7:47:03environmental pollution, and certain
7:47:05viral infections like herpes virus.
7:47:07Alzheimer's disease progresses through
7:47:09seven distinct stages. Stage one
7:47:11involves no impairment. Patients have
7:47:13normal functioning without noticeable
7:47:15symptoms. Stage two involves very mild
7:47:18cognitive decline. Patients may
7:47:20experience slight forgetfulness, but
7:47:21it's generally not noticeable. Stage
7:47:24three includes mild cognitive decline,
7:47:26where short-term memory loss becomes
7:47:28noticeable to family members and close
7:47:30friends. Stage four involves moderate
7:47:33cognitive decline, where patients may
7:47:35experience noticeable personality
7:47:36changes and begin forgetting their
7:47:38personal history. Stage five is
7:47:41characterized by moderately severe
7:47:42cognitive decline. At this point,
7:47:45patients require assistance with
7:47:46activities of daily living and may
7:47:48forget important personal information
7:47:50such as their address. Stage six is
7:47:52severe cognitive decline. In this stage,
7:47:55patients may experience incontinence,
7:47:57wandering behavior, and significant
7:47:59difficulties communicating. Stage seven,
7:48:01the final stage, is very severe
7:48:03cognitive decline. Patients lose the
7:48:05ability to speak, become completely
7:48:07dependent on caregivers, and often have
7:48:09difficulty swallowing. Diagnosis of
7:48:12Alzheimer's disease can be challenging
7:48:14as there is no definitive test.
7:48:16Diagnosis is made primarily through
7:48:17clinical assessment. Imaging tests such
7:48:20as magnetic resonance imaging or
7:48:22computed tomography scans can be used to
7:48:23rule out other potential causes.
7:48:25Healthcare providers also frequently use
7:48:27the mini mental state exam to evaluate
7:48:29the level of cognitive decline. Several
7:48:31nursing interventions can significantly
7:48:33improve the quality of life for patients
7:48:35with Alzheimer's disease. Nurses should
7:48:37frequently reorient patients using items
7:48:40such as clocks, calendars, and familiar
7:48:42photographs. Using short, simple
7:48:44instructions with repetition and
7:48:46consistency is helpful. Establishing a
7:48:48structured daily routine reduces
7:48:49confusion and avoiding overstimulation
7:48:52like loud noises or excessive visitors
7:48:54can keep patients calm. To manage
7:48:56incontinence, it's important to maintain
7:48:58a regular toileting schedule. Finally,
7:49:01encouraging independence with daily
7:49:02activities for as long as safely
7:49:04possible can help preserve the patients
7:49:06dignity. When caring for Alzheimer's
7:49:08patients at home, certain safety
7:49:10measures are crucial. Floors should
7:49:12remain clutter-free and loose rugs
7:49:14should be removed to prevent falls.
7:49:16Locks should be installed on doors and
7:49:18windows since patients may wander away
7:49:20from home. Night lights should be used
7:49:22to reduce nighttime confusion and
7:49:24brightly colored tape should be placed
7:49:25at the edges of stairs for better
7:49:27visibility. Additionally, lowering beds
7:49:30or placing mattresses on the floor can
7:49:32help prevent injuries from falls.
7:49:34Several medications are used in the
7:49:36management of Alzheimer's disease.
7:49:38Donapzel prevents the breakdown of
7:49:40acetylcholine, helping to improve
7:49:41memory. Restigmine and galantamine are
7:49:45chonestase inhibitors that slow disease
7:49:47progression. Mantine blocks NM MDA
7:49:51receptors to protect brain cells.
7:49:52Antiscychotics like haloperidol and
7:49:55resperidone may be used for severe
7:49:56agitation but should always be
7:49:58considered a last resort. Potential
7:50:01complications of Alzheimer's include
7:50:02aspiration pneumonia due to difficulty
7:50:05swallowing, wandering and falls which
7:50:07require careful home safety precautions
7:50:09and malnutrition or dehydration making
7:50:12nutritional monitoring essential. Let's
7:50:15summarize important ANCLEX nursing
7:50:17priorities for Alzheimer's disease.
7:50:19Frequently reorient the patient using
7:50:21calendars, clocks, and familiar objects.
7:50:24Maintain a structured and consistent
7:50:26environment to reduce confusion. Ensure
7:50:28home safety by removing rugs, installing
7:50:30secure door locks, and using
7:50:31nightlights. Encourage independence and
7:50:34activities of daily living, but provide
7:50:36supervision when necessary. Closely
7:50:38monitor swallowing and offer thickened
7:50:40liquids if difficulty swallowing, known
7:50:42as dysphasia, is present. Now, let's
7:50:45practice with two enlex style questions.
7:50:48First question. A nurse is caring for a
7:50:50client with Parkinson's disease who has
7:50:52difficulty swallowing. Which
7:50:54intervention should the nurse include in
7:50:56the client's plan of care? Option A,
7:51:00encourage the client to tilt their head
7:51:01backward while swallowing?
7:51:03Option B, offer thin liquids to help
7:51:06with swallowing. Option C, keep suction
7:51:09equipment at the bedside. Option D,
7:51:11provide large meals three times a day to
7:51:14ensure adequate nutrition. The correct
7:51:16answer is option C. Keep suction
7:51:18equipment at the bedside. The rationale
7:51:20is that clients with Parkinson's disease
7:51:22have an increased risk of aspiration
7:51:23pneumonia due to difficulty swallowing
7:51:25and excess drooling. Having suction
7:51:27equipment ready helps clear secretions
7:51:29promptly and prevents aspiration. Option
7:51:32A is incorrect because clients should
7:51:34tilt their head forward in what is
7:51:36called the chin tuck position, not
7:51:37backward to avoid aspiration. Option B
7:51:40is incorrect because thin liquids
7:51:42increase choking risk. Instead,
7:51:44thickened liquids are preferred. Option
7:51:46D is incorrect since smaller frequent
7:51:49meals are easier to tolerate than large
7:51:51meals. Second question, a nurse is
7:51:54teaching the family of a client with
7:51:55moderate stage Alzheimer's disease about
7:51:57home safety modifications. Which
7:51:59statement by the family indicates a need
7:52:01for further teaching? Option A, we will
7:52:04install door locks that cannot be easily
7:52:06opened. Option B, we will use bright
7:52:09colored tape at the edges of stairs.
7:52:12Option C, we will place mirrors
7:52:14throughout the house to help with
7:52:15recognition. Option D, we will remove
7:52:18all loose rugs from the home. The
7:52:21correct answer is option C, we will
7:52:24place mirrors throughout the house to
7:52:26help with recognition.
7:52:28The rationale here is that patients with
7:52:30Alzheimer's disease can become confused
7:52:32or agitated when seeing reflections,
7:52:34leading to increased distress.
7:52:36Therefore, mirrors should be removed or
7:52:38covered if they cause issues. Option A
7:52:40is correct. Installing secure locks
7:52:43prevents wandering, which is a major
7:52:45safety concern. Option B is correct.
7:52:47Bright colored tape increases visibility
7:52:49and reduces fall risk. Option D is
7:52:52correct. Removing rugs prevents tripping
7:52:54hazards. Passing the Enclelex doesn't
7:52:57have to be hard. With the right
7:52:58strategy, you can pass on your first
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7:53:36get 70% off. Click the link in the
7:53:39description and start your enclelex
7:53:40journey today. Let's start with multiple
7:53:43sclerosis commonly known as MS. Multiple
7:53:46sclerosis is an autoimmune disorder that
7:53:48causes demyelination in the central
7:53:50nervous system including both the brain
7:53:52and spinal cord. Plaques form
7:53:54specifically in the white matter
7:53:55damaging the protective myelin sheath
7:53:57around nerves. This damage disrupts
7:54:00normal nerve impulse transmission. The
7:54:02condition is chronic, progressive, and
7:54:04currently has no cure, but it typically
7:54:06has periods of relapse and remission. Uh
7:54:09certain factors increase the risk of
7:54:10developing MS. It usually affects
7:54:13individuals aged between 20 and 40 years
7:54:15and is more commonly seen in women. Both
7:54:18genetic factors and environmental
7:54:20influences play a role. There are
7:54:22specific triggers that can cause an
7:54:24exacerbation or worsening of symptoms in
7:54:26MS patients. These triggers include
7:54:29infections, especially viral illnesses,
7:54:31extreme temperatures like hot or cold
7:54:33weather, emotional stress, fatigue,
7:54:35pregnancy, and physical injuries.
7:54:37Patients with MS experience several
7:54:40clinical symptoms. Visual disturbances
7:54:42are common, including double vision,
7:54:44known as dipopia, involuntary eye
7:54:46movements, or nestagmas, optic nuritis,
7:54:49and blurred vision. Sensory changes can
7:54:51also occur such as ringing in the ears
7:54:53known as tonitis, decreased hearing
7:54:55ability, numbness, and tingling
7:54:57sensations. Motor dysfunction often
7:54:59includes muscle spasticity, weakness,
7:55:01difficulty swallowing known as
7:55:03dysphasia, slurred speech, and tremors.
7:55:06Additionally, patients may experience
7:55:08bowel and bladder issues such as
7:55:10incontinence or urinary retention,
7:55:12cognitive impairments including poor
7:55:13judgment and memory loss, and sexual
7:55:16dysfunction. Diagnosis of MS involves
7:55:18imaging studies such as MRI which reveal
7:55:21plaques in the brain and spinal cord.
7:55:23Another test, lumbar puncture, shows
7:55:25increased immunogloabbulin G levels.
7:55:28Medications for MS management include
7:55:30cycllosporine, an imunosuppressant that
7:55:32reduces relapse frequency and
7:55:34predinosone, a corticosteroid with
7:55:36anti-inflammatory properties that helps
7:55:38reduce exacerbations.
7:55:40Muscle relaxants like dantrine, pcloin,
7:55:43and dasipam are often used to manage
7:55:45muscle spasticity. Nursing
7:55:47responsibilities important for the anlex
7:55:49exam include encouraging patients to
7:55:50avoid known triggers like hot showers,
7:55:52stress, and infections. Patients should
7:55:55have fall precautions in place due to
7:55:57muscle weakness and impaired
7:55:58coordination. Nurses should closely
7:56:00monitor swallowing and speech to prevent
7:56:02aspiration. Bladder training and
7:56:04intermittent catheterization may be
7:56:06required if urinary retention occurs.
7:56:08Additionally, nurses should encourage
7:56:10regular rest periods to prevent fatigue
7:56:12and promote physical therapy to maintain
7:56:13mobility and function. Now, let's move
7:56:16on to myotrophic lateral sclerosis
7:56:18commonly known as ALS. ALS is a
7:56:21progressive neurodeenerative disorder
7:56:23that affects both upper and lower motor
7:56:25neurons. It leads to muscle atrophy,
7:56:27paralysis, and ultimately respiratory
7:56:29failure. There is no known cure for ALS
7:56:32and patients typically pass away within
7:56:343 to 5 years after diagnosis due to
7:56:36respiratory complications. Importantly,
7:56:39cognitive functions remain intact,
7:56:41meaning the patient is fully aware of
7:56:42their condition and its progression.
7:56:44Common symptoms of ALS include muscle
7:56:46weakness and atrophy that typically
7:56:48start in the extremities and then
7:56:49progress towards the core muscles.
7:56:51Patients often experience difficulty
7:56:53swallowing or dysphasia leading to a
7:56:55high risk of aspiration. Slur speech
7:56:58known medically as disarthria is common.
7:57:01Eventually, respiratory muscles weaken
7:57:03leading to respiratory failure which is
7:57:05the main cause of death. Diagnosis
7:57:07involves electromyiography or EMG which
7:57:11detects loss of motor neuron function.
7:57:13Elevated levels of creatine or CK may
7:57:16also be present due to muscle breakdown.
7:57:19The medication ruzole is a glutamate
7:57:21antagonist used to slow disease
7:57:23progression. Complications include
7:57:25pneumonia caused by aspiration and
7:57:27respiratory failure due to progressive
7:57:29paralysis. Nursing responsibilities
7:57:32essential for ALS care include
7:57:34maintaining airway patency by suctioning
7:57:36secretions as needed, monitoring
7:57:38respiratory status closely, and
7:57:40preparing for mechanical ventilation if
7:57:42necessary. Nurses should take steps to
7:57:44prevent aspiration by elevating the head
7:57:46of the bed during meals or considering a
7:57:48perccutaneous endoscopic gastrotomy tube
7:57:50for nutrition. assisting with
7:57:52communication through writing boards or
7:57:54speech devices, encouraging range of
7:57:56motion exercises to prevent joint
7:57:58stiffness, and providing psychosocial
7:58:00support since the patient is fully aware
7:58:02of their condition are also crucial.
7:58:05Finally, let's discuss mythenia gravis,
7:58:08commonly referred to as MG. Mythenia
7:58:10gravis is an autoimmune disorder
7:58:12affecting the neuromuscular junction. In
7:58:14this condition, antibodies block
7:58:16acetylcholine receptors, preventing
7:58:18muscle contractions. This results in
7:58:21muscle weakness that worsens with
7:58:23activity but improves with rest with
7:58:25periods of exacerbation and remission.
7:58:28Risk factors and triggers include
7:58:29fatigue, infections or illnesses,
7:58:32pregnancy, extreme temperatures like hot
7:58:34water or infections and thymus gland
7:58:37hyperplasia. Patients often experience
7:58:39muscle weakness particularly worsening
7:58:41with activity and improving after rest.
7:58:44Visual symptoms like double vision or
7:58:46dipopia and drooping eyelids known
7:58:48astois are common. Other symptoms
7:58:50include difficulty swallowing called
7:58:52dysphasia, slurred speech, and
7:58:54respiratory muscle weakness increasing
7:58:56the risk for respiratory failure.
7:58:58Additionally, bowel and bladder
7:58:59dysfunction leading to incontinence may
7:59:01occur. Diagnostic tests include the
7:59:04tenselon test, also known as the
7:59:07edphonium test. If symptoms improve with
7:59:09tenselon mg is confirmed. However, if
7:59:12symptoms worsen, it indicates a
7:59:14cononergic crisis or excessive
7:59:16acetylcholine. In such cases, atropene
7:59:19is administered as the antidote. EMG
7:59:22typically shows decreased muscle
7:59:23response, an imaging like CT or MR. I
7:59:27may detect thyoma, a tumor of the thymus
7:59:30gland. Medications used in MG include
7:59:33pyido stigmine and neostigmine which are
7:59:36colonestase inhibitors that prevent the
7:59:38breakdown of acetylcholine thus
7:59:40improving muscle strength.
7:59:42Corticosteroids like predinisone reduce
7:59:44autoimmune responses. Other treatments
7:59:46include plasma feresis which removes
7:59:48harmful antibodies, intravenous
7:59:50immunogloabbulin therapy and thyctomy
7:59:53which involves the removal of the thymus
7:59:55gland. It's critical for anklelex
7:59:58preparation to understand the difference
7:59:59between mythenic crisis and cononergic
8:00:02crisis. In my crisis, there is too
8:00:04little acetal coline causing severe
8:00:07muscle weakness and respiratory failure
8:00:09which improves with tensilon. Treatment
8:00:11involves giving pyroost stigmine inurgic
8:00:14crisis. There is too much acetylcholine
8:00:16leading to muscle twitching, slow heart
8:00:18rate called brady cardia and sweating
8:00:20which worsens with tenselon.
8:00:22Atropene is given as treatment. Nursing
8:00:25responsibilities for MG include
8:00:26maintaining a patent airway with
8:00:28emergency intubation equipment nearby,
8:00:30providing small frequent high calorie
8:00:32meals to prevent fatigue, positioning
8:00:34patients upright during meals to reduce
8:00:36aspiration risk, adding thickeners to
8:00:38food for easier swallowing, providing
8:00:40lubricating eye drops due to difficulty
8:00:42blinking, and taping eyelids shut at
8:00:44night to prevent corial damage damage.
8:00:47Key enclelex tips include prioritizing
8:00:49respiratory function in ALS and MG due
8:00:52to high risks of respiratory failure,
8:00:54implementing fall precautions for MS
8:00:56patients due to muscle weakness and
8:00:57coordination issues, understanding the
8:00:59difference clearly between mythenic
8:01:01crisis and conurgic crisis and
8:01:03recognizing the importance of the
8:01:04tenselon test ensuring atropine is
8:01:07always available. Let's discuss some
8:01:10important enclelex style questions along
8:01:12with their ration. First, a nurse is
8:01:14educating a patient with multiple
8:01:16sclerosis about managing their symptoms.
8:01:18Which statement by the patient indicates
8:01:19that further teaching is needed? Option
8:01:22A says, I should avoid hot showers and
8:01:24baths? Option B says, stress can worsen
8:01:27my symptoms, so I should find ways to
8:01:29relax. Option C says, I will take
8:01:32frequent rest breaks throughout the day.
8:01:34Option D says, I will increase my daily
8:01:36exercise routine to prevent fatigue. The
8:01:39correct answer is option D. I will
8:01:41increase my daily exercise routine to
8:01:43prevent fatigue. The rationale behind
8:01:45this is that overexertion can actually
8:01:48trigger exacerbations of multiple
8:01:50sclerosis. Patients should balance
8:01:52activity with rest to avoid fatigue.
8:01:54Next, a nurse is monitoring a patient
8:01:55with amiotrophic lateral sclerosis, also
8:01:58known as ALS. Which complication is the
8:02:01most common cause of death in this
8:02:02condition? Option A, cardiovascular
8:02:05collapse? Option B, renal failure.
8:02:08Option C, respiratory failure. Option D,
8:02:11severe nurse is monitoring a patient
8:02:13with amiotrophic lateral sclerosis, also
8:02:16known as ALS. Which complication is the
8:02:18most common cause of death in this
8:02:20condition? Option A, cardiovascular
8:02:23collapse? Option B, renal failure.
8:02:26Option C, respiratory failure. Option D,
8:02:29severe muscle spasms. The correct answer
8:02:31is option C, respiratory failure. The
8:02:34rationale here is that ALS leads to
8:02:36progressive weakening of respiratory
8:02:37muscles ultimately causing respiratory
8:02:39failure which is which is the most
8:02:41common cause of death. Now let's look at
8:02:44a nurse preparing to administer
8:02:46hedrophonium also called tenselon to a
8:02:48patient suspected of having myastthenia
8:02:50gravis. What should the nurse do before
8:02:53administering this medication? Option A,
8:02:56ensure atropene is available. Option B,
8:02:59place the patient in trendelenberg
8:03:00position. Option C, administer oxygen
8:03:03through nasal canula. Option D, have the
8:03:06patient perform deep breathing
8:03:07exercises. The correct answer is option
8:03:09A, ensure atropene is available. The
8:03:12rationale for this is that edrophonium
8:03:14can cause a conurgic crisis and atropene
8:03:17acts as an antidote. So it must be
8:03:19readily available in case of severe
8:03:21slowing of the heart rate or respiratory
8:03:23distress. Now moving on to eye
8:03:26disorders. Good vision is essential for
8:03:28daily life and various eye disorders can
8:03:30impair sight. Let's discuss some key
8:03:33conditions, their symptoms, treatments,
8:03:35and nursing responsibilities.
8:03:37First, macular degeneration.
8:03:40Macular degeneration is the progressive
8:03:42degeneration of the macula leading to
8:03:44central vision loss primarily affecting
8:03:46adults over 60 years old. There are two
8:03:49types. dry, also known as non-exudative,
8:03:52which is the most common and progresses
8:03:54slowly due to drusen deposits, and wet,
8:03:57also called exudative, which is more
8:03:59severe and progresses rapidly because of
8:04:01abnormal blood vessel growth. Common
8:04:04symptoms include blurred vision, loss of
8:04:06central vision, causing difficulty
8:04:07reading or recognizing faces, visual
8:04:10distortions where straight lines appear
8:04:11wavy, and difficulty seeing in low
8:04:13light. While there's no cure,
8:04:16progression can be slowed with
8:04:17antioxidants, keratene, vitamin E,
8:04:20vitamin B12, and zinc. Anti-ve GF
8:04:23therapy like ranabismab or bevacismab
8:04:27can help inhibit abnormal vessel growth
8:04:29in the wet type. Laser therapy and
8:04:32photodnamic therapy might also be used.
8:04:34Nursing responsibilities include
8:04:36encouraging a diet rich in leafy greens,
8:04:38fish, and vitamins, providing low vision
8:04:40aids such as magnifiers or large print
8:04:43books, referring patients to community
8:04:45resources for assistance with daily
8:04:47activities, and educating them on home
8:04:49safety measures to prevent falls like
8:04:51removing rugs and improving lighting.
8:04:54Next, cataracts. Cataracts involve the
8:04:56lens becoming opaque, causing
8:04:58progressive and painless vision loss.
8:04:59Symptoms include blurred vision, double
8:05:02vision, also known as dipopia,
8:05:04sensitivity to glare and light, seeing
8:05:06halos around lights, and an absent red
8:05:09reflex during an opthalmoscopic exam.
8:05:11The definitive treatment is surgical
8:05:13removal of the cloudy lens with an
8:05:14artificial lens implantation.
8:05:17Post-operative nursing responsibilities
8:05:18focus on preventing increased
8:05:20intraocular pressure. Patients should
8:05:22avoid bending at the waist, sneezing,
8:05:24coughing, straining, or lifting objects
8:05:26heavier than 10 lbs. They should also
8:05:28avoid tilting the head backward, rapid
8:05:30movements, driving or high impact
8:05:32activities. Patients must use prescribed
8:05:35eye drops, avoid rubbing their eyes, and
8:05:37wear sunglasses outdoors to reduce glare
8:05:39and UV exposure. Immediately report any
8:05:42yellow or green discharge indicating
8:05:43infection or sudden sharp eye pain,
8:05:46nausea or vomiting, suggesting increased
8:05:48pressure inside the eye. Complete
8:05:51healing typically occurs within 4 to 6
8:05:53weeks. Finally, glaucoma. Glaucoma
8:05:56refers to increased intraocular pressure
8:05:58leading to optic nerve damage and vision
8:06:00loss. There are two main types. First,
8:06:03open angle glaucoma which is the most
8:06:06common and has a gradual onset due to
8:06:08partial blockage of the eyes drainage
8:06:10system. Symptoms include loss of
8:06:12peripheral vision, mild eye pain and
8:06:14increased pressure above 21 mm of
8:06:17mercury. Second, closed angle glaucoma,
8:06:20a medical emergency with sudden onset
8:06:22due to complete blockage of aquous humor
8:06:24drainage. Symptoms are severe eye pain,
8:06:27headache, nausea, vomiting, halos around
8:06:30lights, blurred vision, sensitivity to
8:06:32light, and significantly elevated eye
8:06:34pressure. Treatment includes medications
8:06:36such as pyocarpine to constrict pupils,
8:06:39timolal beta blockers to reduce fluid
8:06:41production, manitol as an emergency
8:06:43measure, and aetylolomide to decrease
8:06:46fluid production. Surgery like laser
8:06:48taculoplasty or iridottomy may be needed
8:06:51if medications aren't effective. Nursing
8:06:53responsibilities include correctly
8:06:55administering eye drops by waiting 5
8:06:57minutes between different medications,
8:06:59applying gentle pressure to the inner
8:07:01corner of the eye to prevent systemic
8:07:03absorption, and ensuring the dropper tip
8:07:05doesn't touch the eye. Educate patients
8:07:08to avoid actions increasing intraocular
8:07:10pressure like bending at the waist,
8:07:12straining, coughing, sneezing, lifting
8:07:14heavy objects, and avoiding dark rooms
8:07:17to prevent pupil dilation. Regular eye
8:07:19exams every 6 to 12 months are important
8:07:21for monitoring eye pressure. Retinal
8:07:24detachment is a condition where the
8:07:25retina separates from its underlying
8:07:27tissue. This condition can lead to
8:07:29permanent vision loss if it's not
8:07:31treated promptly. Several causes
8:07:33contribute to retinal detachment,
8:07:35including aging, trauma, diabetes, and
8:07:37myopia, commonly known as
8:07:40nearsightedness.
8:07:42Patients with retinal detachment usually
8:07:43experience sudden floaters, which appear
8:07:45as black spots floating in their vision.
8:07:48They may also notice flashes of light
8:07:50known medically as phototopsia. Another
8:07:52significant symptom is a curtain-like
8:07:54shadow affecting their vision.
8:07:56Importantly, retinal detachment causes
8:07:59painless but progressively worsening
8:08:01vision loss. Treatment for retinal
8:08:03detachment typically requires emergency
8:08:05surgery. Procedures like scaral buckle,
8:08:07pneumatic retinopexy or vitrectomy may
8:08:10be performed. Additionally, laser
8:08:12photocoagulation or cryotherapy can help
8:08:15seal tears in the retina. Postoperative
8:08:17care is critical in managing patients
8:08:19after retinal detachment surgery.
8:08:21Correct positioning is extremely
8:08:22important and depends on the type of
8:08:24surgery performed. For example, after
8:08:27pneumatic retinopexi, patients must lie
8:08:30face down to ensure the gas bubble used
8:08:32in the surgery remains correctly
8:08:33positioned. Nurses should instruct
8:08:35patients to report immediately any
8:08:37sudden increases in pain, loss of
8:08:39vision, or the appearance of new
8:08:41floaters as these could indicate
8:08:43redetachment. Patients also need
8:08:45thorough education about avoiding
8:08:47activities that can increase
8:08:48intraoccular pressure. These include
8:08:50straining, heavy lifting, bending,
8:08:53sneezing, or coughing. Using prescribed
8:08:56eye drops is essential to prevent
8:08:58infection. Furthermore, patients must
8:09:00avoid air travel until cleared by their
8:09:02doctor because gas bubbles can expand at
8:09:04high altitudes. Now, for the enclelex
8:09:07exam, remember these key nursing
8:09:09priorities. First, patient positioning
8:09:11after retinal detachment surgery is a
8:09:13frequently tested topic. Second,
8:09:16postcataract surgery care focuses
8:09:18heavily on infection prevention and
8:09:19avoiding straining. Third, glaucoma
8:09:22medication administration and avoiding
8:09:24activities that increase intraocular
8:09:26pressure are crucial areas. Fourth,
8:09:29differentiating between early and late
8:09:31signs of macular degeneration is
8:09:33important. Lastly, recognizing acute
8:09:35angle closure glaucoma as a medical
8:09:37emergency is critical. Let's look at
8:09:39some enlex style questions. Question one
8:09:42addresses postcataract surgery care. A
8:09:44nurse gives discharge instructions to a
8:09:46patient after cataract surgery. Which
8:09:48patient statement indicates the need for
8:09:50additional teaching? A. I will wear
8:09:53sunglasses when going outside. B. I
8:09:56should avoid lifting anything heavier
8:09:58than 10 lb. C. If I have mild eye
8:10:01itching, I should rub my eye gently. D.
8:10:05I will report any yellow or green
8:10:07drainage from my eye to my health care
8:10:09provider. The correct answer is C
8:10:11because patients should never rub their
8:10:13eyes after cataract surgery to prevent
8:10:15infection and lens displacement. Mild
8:10:17itching can be relieved by prescribed
8:10:20eye drops. Question two covers glaucoma
8:10:22medications. A nurse administers timolal
8:10:25eye drops to a patient with open angle
8:10:27glaucoma. What's the most important
8:10:29nursing action during this procedure?
8:10:32A. Tell the patient to close their eyes
8:10:34tightly after giving drops. B. Apply
8:10:37pressure to the inner corner of the eye
8:10:39known as the lacrimal duct for 30 to 60
8:10:42seconds. C. Instruct the patient to
8:10:44blink rapidly to distribute the
8:10:46medication. D. Put the drops directly
8:10:49onto the cornea for better absorption.
8:10:51The correct answer here is B. Timolal is
8:10:54a beta blocker and applying pressure to
8:10:56the inner corner prevents systemic
8:10:58absorption reducing risks like bradic
8:11:00cardia or low blood pressure. Eye drops
8:11:04should be placed in the conjunctival
8:11:05sack, not on the cornea. Let's be real,
8:11:08failing. The enclelex is not an option.
8:11:11It means wasting time. It means delaying
8:11:12your career. It means another round of
8:11:14stress and anxiety. But here's the good
8:11:16news. You don't have to risk failure.
8:11:18With our 99% passing rate and crash
8:11:21course, you'll have everything you need
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8:11:57today. Next, we discuss ear disorders,
8:12:00specifically otitis media or middle ear
8:12:02infections. Several risk factors
8:12:04increase the likelihood of developing
8:12:06otitis media. These include these
8:12:08include frequent colds or respiratory
8:12:10infections, enlarged adenoids blocking
8:12:12the ustaceian tubes, exposure to tobacco
8:12:15smoke, bottlefeeding infants while lying
8:12:17flat, and allergies or sinus infections.
8:12:21Common symptoms include ear pain known
8:12:23as otalgia, irritability, especially in
8:12:26young children, a red, inflamed bulging
8:12:29eardrum with visible fluid or bubbles,
8:12:32hearing loss, fever, headache, and ear
8:12:34drainage if the eardrum ruptures.
8:12:36Nursing responsibilities for patients
8:12:38with otitis media involve assessing for
8:12:40ear pain or infection signs,
8:12:42particularly in children who may pull
8:12:43their ears or become unusually fussy or
8:12:45restless. When administering ear drops,
8:12:48nurses must pull the ear differently
8:12:50based on age. For children under 3 years
8:12:52old, pull the ear down and back, while
8:12:54for adults, pull it up and back.
8:12:56Additionally, educating parents about
8:12:58completing antibiotic courses fully,
8:13:00encouraging fluid drainage by elevating
8:13:02the child's head, and teaching
8:13:03prevention strategies such as
8:13:04breastfeeding and avoiding supine bottle
8:13:06feeding are essential parts of nursing
8:13:09care. Manier's disease is an inner ear
8:13:12disorder characterized by a classic
8:13:14triad of symptoms. The first symptom is
8:13:16tonitis, which means a ringing sensation
8:13:18in the ears. The second symptom is
8:13:20unilateral sensory neural hearing loss,
8:13:22meaning hearing loss affecting only one
8:13:24ear. The third classic symptom is
8:13:26vertigo, a spinning sensation that comes
8:13:29in episodes and can last anywhere from
8:13:30several hours to a few days. Certain
8:13:33risk factors can increase the likelihood
8:13:34of developing minier's disease. These
8:13:37include viral or bacterial infections
8:13:39that damage the inner ear, medications
8:13:41that are harmful to the ears called
8:13:43otoxic medications. Apart from the
8:13:46classic symptoms, patients may
8:13:48experience additional signs like
8:13:50anestagmas which is involuntary eye
8:13:52movements, nausea, vomiting, problems
8:13:55with balance and increased sensitivity
8:13:58to loud sounds. Nurses play a crucial
8:14:00role in managing patients with miners's
8:14:02disease, especially during acute
8:14:04attacks. Safety always comes first, so
8:14:07nurses must implement fall precautions
8:14:09by keeping the bed at its lowest
8:14:10position and raising side rails. To
8:14:13minimize symptoms, the patient should be
8:14:14placed in a quiet, dark environment to
8:14:16reduce stimuli and encourage to rest.
8:14:19Nurses should also administer prescribed
8:14:20medications such as mechazine, which
8:14:23helps relieve vertigo.
8:14:25Patient education is equally important
8:14:27in managing minier's disease. Patients
8:14:29should be advised to avoid caffeine,
8:14:31alcohol, smoking, and high salt intake
8:14:33as these substances can increase fluid
8:14:35retention in the inner ear and worsen
8:14:38symptoms. It is also helpful to space
8:14:40out fluid intake throughout the day
8:14:42rather than drinking large amounts at
8:14:43once. Patients should lie down
8:14:45immediately when they begin to
8:14:47experience vertigo.
8:14:49Odotoxic medications are drugs that can
8:14:51cause damage to the ear and should be
8:14:53recognized and managed carefully.
8:14:55Examples of these medications include
8:14:57aminoglycosside antibiotics such as
8:14:59genttoen and amikatin, antibiotics like
8:15:03metroniditool, certain diuretics such as
8:15:05fiomide also known by its brand name
8:15:08Lasix, chemotherapy agents and other
8:15:10drugs like antiolinerics, antihistamines
8:15:14often used for nausea, vomiting and
8:15:15tonitis and duporidol which is commonly
8:15:18given for nausea and vomiting.
8:15:20Recognizing and managing these
8:15:22medications can help prevent further
8:15:23damage to hearing and balance in
8:15:25patients.
8:15:27Let's discuss head injuries,
8:15:28specifically traumatic brain injury.
8:15:31It's crucial for nurses to immediately
8:15:33stabilize the cervical spine, known as
8:15:35C-spine precautions, especially if the
8:15:38patient had a car accident or a fall.
8:15:40This is done until any spinal injury is
8:15:42ruled out. Next, nurses must carefully
8:15:44assess for increased intraanial
8:15:46pressure. Monitoring the patient's
8:15:48glazoma scale is essential because a
8:15:50score of eight or less indicates a
8:15:52severe brain injury.
8:15:54Early signs of increased intraraanial
8:15:56pressure include irritability and
8:15:58restlessness, often the first
8:15:59indicators. Patients may also experience
8:16:02headaches, projectile vomiting without
8:16:04feeling nauseous, and altered
8:16:05consciousness such as drowsiness or
8:16:07confusion. Late signs become more severe
8:16:10and include fixed dilated pupils that
8:16:12don't respond to light and something
8:16:14called Cushing's triad. This triad
8:16:17consists of three main symptoms.
8:16:19Increased blood pressure with a widened
8:16:21pulse pressure, braticardia or slow
8:16:23heart rate and irregular respirations
8:16:25which may include patterns like Cheney
8:16:27Stokes breathing or even apnea.
8:16:30Additional late signs are abnormal
8:16:32posturing known as decorticate or
8:16:34decerebrate posturing and leakage of
8:16:36cerebral spinal fluid from the nose or
8:16:38ears. Nurses can detect this leakage by
8:16:41the halo sign, which is blood surrounded
8:16:43by a yellowish ring on bed sheets or by
8:16:45testing the fluid for glucose,
8:16:46confirming its cerebral spinal fluid if
8:16:48positive. Now, let's focus on high yield
8:16:51nursing responsibilities for managing
8:16:53increased ICP.
8:16:55Nurses must always prioritize airway,
8:16:57breathing, and circulation. They also
8:16:59need to control carbon dioxide levels
8:17:01because high carbon dioxide can further
8:17:03elevate ICP.
8:17:05Hyperventilating the patient helps
8:17:06reduce carbon dioxide levels, aiming for
8:17:09normal ranges between 35 to 45 mm of
8:17:12mercury. Activities that could raise
8:17:14intraanial pressure should be strictly
8:17:16avoided. This includes avoiding frequent
8:17:18suctioning, preventing the patient from
8:17:20blowing their nose or straining, and
8:17:22administering stool softeners to prevent
8:17:23constipation. Nurses should ensure
8:17:26urinary catheters function well to avoid
8:17:28additional abdominal pressure. It's
8:17:30important to keep the head of the bed
8:17:31elevated at less than 30° but for
8:17:33surgeries below the tentorum cerebelli
8:17:36known as infratorctoral surgeries the
8:17:38patient should remain flat. Also nurses
8:17:41must keep the patients neck in a neutral
8:17:43position avoiding any flexing or
8:17:45extending. Medications commonly given
8:17:47for increased intraanial pressure
8:17:49include manitol an osmotic diuretic that
8:17:52reduces cerebral swelling but requires
8:17:54close electrolyte monitoring.
8:17:56Mentoarbital is used to decrease brain
8:17:58metabolism, phenotin to prevent seizures
8:18:01and morphine or fentanyl for pain
8:18:02management, noting the risk of
8:18:04respiratory depression. Regarding
8:18:06surgical management, a cranottomy might
8:18:07be performed which involves removing a
8:18:09bone flap to relieve pressure. After
8:18:12surgery, positioning varies. For
8:18:14superenoral procedures, meaning above
8:18:16the tentorum cerebelli, the head of the
8:18:18bed is raised to 30°. For infrretenial
8:18:22procedures, typically involving the
8:18:23brain stem, the patient stays flat on
8:18:25either side to avoid pressure on the
8:18:27incision site. Several complications can
8:18:29arise from head injuries, including
8:18:31brain herniation, diabetes incipitus or
8:18:33DI syndrome of inappropriate
8:18:35antidiuretic hormone known as Si Ah, and
8:18:38cerebral salt wasting syndrome
8:18:40abbreviated as CSWS.
8:18:43Brain herniation signs include dilated
8:18:45pupils, loss of consciousness, abnormal
8:18:47posturing, and irregular breathing.
8:18:50Diabetes incipitus occurs due to
8:18:52pressure on the hypothalamus leading to
8:18:54excessive urine output, dehydration, and
8:18:56high sodium levels. In contrast, SiDh
8:19:00caused by excessive antidiuretic hormone
8:19:02secretion results in fluid retention,
8:19:05low sodium levels, and decreased urine
8:19:07output. Cerebral salt wasting syndrome
8:19:10leads to low sodium, dehydration, and
8:19:12decreased blood volume. High yield
8:19:14nursing actions for these complications
8:19:16are critical. Brain herniation is an
8:19:18emergency. Nurses must notify the
8:19:20healthcare provider immediately and
8:19:22prepare for potential intubation and
8:19:24surgery. For diabetes and cypitus,
8:19:26monitor urine output, administer
8:19:28desmopressin, also known as DD-AVP, and
8:19:31rehydrate the patient. Managing SI ADH
8:19:34involves fluid restriction and
8:19:36administering hypertonic saline. 3% if
8:19:39needed. For cerebral salt wasting
8:19:41syndrome, intravenous fluids with sodium
8:19:43replacement are necessary along with
8:19:45close electrolyte monitoring. Now let's
8:19:48discuss stroke also known as a
8:19:50cerebrovascular accident. Stroke is a
8:19:53medical emergency that happens when
8:19:55blood flow to the brain is disrupted
8:19:57leading to oxygen deprivation and
8:19:59potentially causing brain cell death.
8:20:01There are three main types of stroke.
8:20:03First is hemorrhagic stroke which occurs
8:20:05when an artery or aneurysm bursts
8:20:07causing bleeding inside the brain.
8:20:08Second is thrombotic stroke which
8:20:11happens when a blood clot called a
8:20:12thrombus forms directly in a brain
8:20:15artery blocking blood flow. Third is
8:20:17emolic stroke where a blood clot called
8:20:19an embolis travels from another part of
8:20:22the body commonly from the heart due to
8:20:24conditions like atrial fibrillation and
8:20:26then blocks a brain artery. Several risk
8:20:28factors can increase the chance of a
8:20:30stroke. Non-modifiable risk factors
8:20:32include age where older adults are at
8:20:34higher risk, family history, gender, as
8:20:37males are more likely affected, and
8:20:39race, particularly African-Americans.
8:20:42Modifiable risk factors, on the other
8:20:44hand, are things we can control such as
8:20:46hypertension, diabetes, malitis,
8:20:48smoking, atrial fibrillation, high
8:20:50cholesterol levels, hyper lipidmia,
8:20:53obesity, lack of exercise, excessive
8:20:55alcohol intake, and corateed artery
8:20:57disease. Signs and symptoms of stroke
8:21:00often include visual disturbances,
8:21:02dizziness, slurred speech, facial
8:21:04drooping, and sudden weakness or
8:21:06paralysis on one side of the body. A
8:21:09helpful way to remember this is the fast
8:21:11pneummonic. Facial droop, arm weakness,
8:21:14speech difficulty, and time to call 911
8:21:16immediately. Stroke symptoms also differ
8:21:19based on which side of the brain is
8:21:21affected. For a left hemisphere stroke
8:21:23which affects the right side of the
8:21:24body, patients often experience deficits
8:21:27in language areas like brocas and
8:21:29vernicas, math skills and analytical
8:21:32thinking. They may have aphasia which is
8:21:34difficulty speaking or understanding
8:21:36language and trouble reading and writing
8:21:37known as alexia and a graphia. They also
8:21:41commonly experience right-sided
8:21:42paralysis or weakness and loss of vision
8:21:44on one or both sides. On the other hand,
8:21:47a right hemisphere stroke affecting the
8:21:49left side of the body leads to
8:21:51difficulties in visual and spatial
8:21:53awareness. These patients may show poor
8:21:56impulse control and judgment, increasing
8:21:58their risk of falls and often neglect or
8:22:01ignore their left side completely. They
8:22:03typically experience left-sided
8:22:04paralysis or weakness. An easy memory
8:22:07aid is left equals language problems and
8:22:10right equals reckless or impulsive
8:22:12behavior. Nursing responsibilities
8:22:14especially important for exams like
8:22:16ANLEX involve acute stroke management.
8:22:19Firstly, assess blood pressure
8:22:20carefully. If the systolic is greater
8:22:22than 180 mm of mercury or the diastolic
8:22:26exceeds 110 mm of mercury, it suggests
8:22:29an eskeemic stroke. For dysphasia
8:22:32precautions, nurses should always check
8:22:33the patients gag reflex before giving
8:22:35anything by mouth. Positioning the
8:22:37patient upright at 90 degrees during
8:22:39meals, teaching the chin tuck method
8:22:41when swallowing, and providing thickened
8:22:42liquids if necessary can help prevent
8:22:44aspiration. Preventing tissue injuries
8:22:46and pressure ulcers is crucial. So,
8:22:49repositioning the patient every 2 hours
8:22:51and using pillows or heel protectors is
8:22:53important. In patients with visual field
8:22:55loss known as homonymous hemianopsia,
8:22:58teach them to use a scanning technique,
8:23:00turning their head fully from the
8:23:02unaffected side toward the affected side
8:23:04when eating or walking. Promoting
8:23:07mobility and safety involves regular
8:23:09range of motion exercises to prevent
8:23:11muscle contraurs, assisting patients
8:23:13with ambulation using a gate belt, and
8:23:15implementing fall precautions like bed
8:23:16alarms, assistive devices, and a
8:23:19clutter-free environment.
8:23:21Regarding medications for stroke,
8:23:23antiplatlets such as aspirin and
8:23:25clipidogil help prevent clot formation.
8:23:27Anti-coagulants including warerin and
8:23:30heperin are used especially in patients
8:23:32with atrial fibrillation to prevent
8:23:34further clotting. Thrombolytic
8:23:36medications known as clotbusters like
8:23:38altiplas must be administered within 4.5
8:23:41hours from symptom onset for eskeemic
8:23:43strokes but must never be used if a
8:23:46hemorrhagic stroke is suspected. In some
8:23:48cases, surgical interventions like
8:23:50corateed artery angoplasty with stenting
8:23:52might be performed to remove clots and
8:23:54open blocked arteries. Finally, patient
8:23:57teaching focuses on stroke prevention,
8:23:59controlling blood pressure and diabetes,
8:24:01regular exercise, maintaining a healthy
8:24:03weight, quitting smoking, limiting
8:24:05alcohol, and consistently taking
8:24:07prescribed anti-coagulants, especially
8:24:10in patients with conditions like atrial
8:24:12fibrillation. Let's quickly review two
8:24:14common enclelex style questions. First,
8:24:17if a patient suddenly develops slurred
8:24:19speech, right-sided weakness, and facial
8:24:21drooping with a blood pressure of 190
8:24:24over 110 millm of mercury, what should
8:24:26the nurse do first? The correct answer
8:24:29is to obtain a blood glucose level
8:24:30because low blood sugar or hypoglycemia
8:24:33can mimic stroke symptoms and it's
8:24:35important to rule that out before
8:24:36initiating stroke treatment. A second,
8:24:38if a stroke patient indicates that
8:24:40drinking thin liquids helps them swallow
8:24:42more easily, this shows the need for
8:24:44further teaching because thin liquids
8:24:46actually increase aspiration risk.
8:24:49Instead, thickened liquids are
8:24:50recommended to help prevent choking and
8:24:52aspiration. Your Enclelex results will
8:24:55decide your future. Will you be
8:24:57celebrating as a licensed nurse, or will
8:24:59you be stuck retaking the exam? Don't
8:25:02leave your success to chance. We've
8:25:04designed the ultimate enclelex crash
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8:25:48Now we will discuss spinal cord injuries
8:25:50also called SCI which happen due to
8:25:53trauma affecting the spinal cord leading
8:25:55to different levels of motor and sensory
8:25:57loss depending on where the injury
8:25:58occurs. First let's understand the
8:26:01classification of SCI based on the
8:26:02injury level. If the injury happens in
8:26:04the cervical spine meaning above
8:26:06thoracic level one known as T1 it
8:26:09results in quadriplegia also called
8:26:11tetroplegia. Quadriplegia means
8:26:13paralysis affecting both arms and legs.
8:26:15Injuries at cervical level four or C4
8:26:17and above affect the frenic nerve. This
8:26:20damage causes respiratory failure,
8:26:22meaning the patient can't breathe
8:26:23effectively on their own and thus needs
8:26:25mechanical ventilation and intubation.
8:26:28If the injury occurs below T1 involving
8:26:30the thoracic or lumbar spine, it results
8:26:33in paraplegia. Paraplegia means loss of
8:26:35function only in the lower extremities
8:26:37while the upper limbs remain functional.
8:26:39An important condition related to spinal
8:26:41cord injury above thoracic level 6 or T6
8:26:44is called neurogenic shock. This happens
8:26:46due to disruption in autonomic pathways.
8:26:49The main symptoms include low blood
8:26:51pressure medically known as hypotension,
8:26:53slow heart rate called bradic cardia,
8:26:56warm and dry skin, loss of the ability
8:26:58to regulate body temperature, and
8:27:00swelling known as dependent edema. To
8:27:03manage neurogenic shock, medications
8:27:05like vasopressors, specifically
8:27:07norepinephrine or dopamine are given to
8:27:10support blood pressure and atropene is
8:27:12used to correct the slow heart rate. Now
8:27:14let's differentiate between upper and
8:27:16lower motor neuron injury effects. If an
8:27:19injury occurs above lumbar level one or
8:27:21two, L1 or L2, it's considered an upper
8:27:24motor neuron injury. This type of injury
8:27:26causes paralysis which results
8:27:29in a neurogenic bladder. That
8:27:32means the bladder contracts
8:27:33involuntarily causing urinary
8:27:35incontinence. On the other hand,
8:27:37injuries below lumbar level one or two,
8:27:39L1 or L2 are lower motor neuron
8:27:42injuries. These result in flaccid
8:27:44paralysis and a flaccid neurogenic
8:27:46bladder. Patients with this condition
8:27:49require intermittent catheterization
8:27:51because their bladder cannot contract
8:27:53effectively. Now, let's talk about
8:27:55symptoms commonly seen in SEI patients.
8:27:57Patients often lose sensation, meaning
8:28:00they can't feel light, touch, or
8:28:01differentiate between sharp and dull
8:28:03stimuli. Deep tendon reflexes, also
8:28:06called DTRS, are usually absent. Flaccid
8:28:10muscle tone is typical in lower motor
8:28:12neuron injuries, while muscle
8:28:14tone appears in upper motor neuron
8:28:16injuries. Hypotension due to autonomic
8:28:19dysfunction is common. Another critical
8:28:21complication seen in injuries above T6
8:28:23is autonomic dysflexia, a
8:28:25life-threatening condition condition.
8:28:27Moving on to nursing interventions and
8:28:29management during the acute phase of
8:28:30spinal cord injury. The first priority
8:28:33is airway and breathing support. Nurses
8:28:35should closely monitor for respiratory
8:28:37failure, especially in cervical SCI
8:28:39above C4 and prepare for mechanical
8:28:42ventilation and intubation when needed.
8:28:44Maintaining hemodynamic stability is
8:28:46crucial. Nurses must watch carefully for
8:28:48signs of neurogenic shock like
8:28:50bradicardia and hypotension. To manage
8:28:53this, vasopressors such as
8:28:54norepinephrine or dopamine are
8:28:56administered and atropene is used to
8:28:58treat severe bradic cardia. Performing
8:29:00regular neurological assessments is
8:29:02essential to detect any changes in
8:29:04sensory and motor functions.
8:29:06Additionally, nurses should assess
8:29:08patients for signs of autonomic
8:29:09dysflexia, especially in injuries above
8:29:12T6.
8:29:13Proper bowel and bladder management is
8:29:15also critical in upper motor neuron
8:29:18injuries causing a bladder
8:29:20scheduled voiding along with
8:29:21anticolinergic medications such as
8:29:23oxybutin are recommended and lower motor
8:29:27neuron injuries with flaccid bladder
8:29:29intermittent catheterization and
8:29:31cononergic medications like bethanol are
8:29:34typically used for bowel management. A
8:29:37daily bowel routine involving stool
8:29:38softeners, a high-fiber diet, and
8:29:40digital rectal stimulation is essential.
8:29:43Another critical role of nurses is
8:29:45preventing complications such as
8:29:47orthostatic hypotension, pressure
8:29:48ulcers, and deep vein thrombosis, also
8:29:51called DVT.
8:29:54To prevent orthostatic hypotension,
8:29:56nurses should help patients change
8:29:57positions slowly, use compression
8:29:59stockings, and abdominal binders. For
8:30:02pressure ulcer prevention, frequent
8:30:03repositioning every 2 hours, skin
8:30:05assessments, and the use of pressure
8:30:07relieving devices are vital. DVT is
8:30:09prevented by giving anti-coagulant
8:30:11medications like heperin or enoxaparin,
8:30:14and using sequential compression devices
8:30:15or SCEDs.
8:30:17Finally, let's review the key
8:30:19medications commonly used in SCI.
8:30:21Glucocorticoids, specifically methyl
8:30:23prediniscolone, help reduce spinal cord
8:30:25swelling during the acute phase.
8:30:28Vasopressors like dopamine or
8:30:29norepinephrine maintain blood pressure
8:30:31during neurogenic shock. Muscle
8:30:34relaxants such as blohin or dantrine
8:30:36treat muscle spasticity seen in upper
8:30:39motor neuron injuries. Anticolonurgics
8:30:42including oxybatin manage a
8:30:44neurogenic bladder and stool softeners
8:30:47like docusate help prevent constipation
8:30:49a common complication for SEI patients.
8:30:52Now let's talk about autonomic
8:30:53dysflexia. A serious medical emergency
8:30:55that can occur in patients with spinal
8:30:57cord injuries above the sixth thoracic
8:30:59vertebra T6. Autonomic dysrelexia
8:31:02happens when there is an excessive
8:31:04sympathetic nervous response triggered
8:31:06by a painful or irritating stimulus and
8:31:08the body cannot balance it out with the
8:31:10parasympathetic nervous system. The most
8:31:12common causes include bladder distension
8:31:14such as from a blocked catheter or a
8:31:16full bladder. Other frequent triggers
8:31:18are fecal impaction, tight clothing or
8:31:21pressure ulcers. Typical symptoms of
8:31:24autonomic disysrelexia are severe
8:31:26hypertension often with a systolic blood
8:31:28pressure higher than 200 millm of
8:31:30mercury along with brady cardia, a
8:31:32pounding headache, sweating above the
8:31:34level of injury, blurred vision, nasal
8:31:36congestion and facial flushing.
8:31:39Immediate nursing interventions for
8:31:40autonomic dysflexia include first
8:31:44immediately sit the patient upright in a
8:31:45high fowler's position. Next, quickly
8:31:48identify and remove the trigger by
8:31:49checking if the bladder is distended and
8:31:51emptying it if necessary. assessing for
8:31:53fecal impaction and removing it if found
8:31:55and loosening any tight clothing.
8:31:58Frequently monitor blood pressure.
8:32:02Administer anti-hypertensive medications
8:32:04such as nifetapine or hydrolysine if the
8:32:06blood pressure stays elevated and notify
8:32:08the health care provider immediately.
8:32:11Let's move on to high yield nursing
8:32:13responsibilities for spinal cord injury
8:32:15SCI patients crucial for enclelex
8:32:18examinations. Priority nursing actions
8:32:20involve assessing airway, breathing, and
8:32:22circulation, often referred to as the
8:32:25ABCs.
8:32:26Regularly monitor the patients
8:32:28neurological status using the Glasggo
8:32:30coma scale and check motor and sensory
8:32:32functions. Recognize and promptly manage
8:32:35neurogenic shock and autonomic
8:32:37dysflexia.
8:32:38Maintain strict immobilization using a
8:32:40cervical collar and other spinal
8:32:42precautions. Prevent complications such
8:32:44as pressure ulcers, deep vein
8:32:46thrombosis, and infections. Educate
8:32:49patients thoroughly on bowel and bladder
8:32:51training. Common enclelex questions
8:32:53regarding spinal cord injuries often
8:32:55include recognizing symptoms of
8:32:57autonomic dysflexia, identifying the
8:32:59first nursing actions when autonomic
8:33:01dysflexia occurs, understanding why
8:33:04patients with injuries at the C4
8:33:05vertebra require mechanical ventilation,
8:33:08knowing interventions to prevent
8:33:10orthostatic hypotension, and determining
8:33:12appropriate medications for bricardia in
8:33:15neurogenic shock. Now let's discuss
8:33:18essential diagnostic and therapeutic
8:33:20procedures like arterial blood gases,
8:33:22broncoscopy, thorosentesis and chest
8:33:25tubes. Arterial blood gases or AGs are
8:33:28vital for assessing oxygenation,
8:33:30ventilation and acidbased balance.
8:33:33Before drawing blood from the radial
8:33:34artery, perform an Allen's test. In this
8:33:37test, compress both the ulner and radial
8:33:39arteries. Release pressure from the
8:33:41ulner artery and ensure capillary refill
8:33:43occurs within 5 to 15 seconds. This
8:33:45confirms arterial patency, meaning it is
8:33:48safe to proceed with the AG procedure.
8:33:50After drawing an arterial blood gas,
8:33:52apply direct pressure at the puncture
8:33:53site for at least 5 minutes. For
8:33:56patients taking anti-coagulants,
8:33:58pressure should be held for at least 20
8:34:00minutes. Monitor closely for
8:34:02complications like a hematoma where firm
8:34:04pressure is needed or an air embolism
8:34:07where immediate treatment includes
8:34:09positioning the patient on their left
8:34:10side in the trendelenburgg position.
8:34:12Symptoms of an air embolism include
8:34:14difficulty breathing, chest pain,
8:34:16anxiety, and the feeling of air hunger.
8:34:19Next, broncoscopy is used to visualize
8:34:21airways, perform biopsies, remove
8:34:23foreign objects, or clear secretions.
8:34:26Before broncoscopy, keep the patient
8:34:27NPO, nothing by mouth, for 8 to 12
8:34:30hours. Administer viscous lidocaine or a
8:34:33local anesthetic throat spray to numb
8:34:35the throat and sometimes atropene is
8:34:37given to reduce secretions and prevent
8:34:39aspiration. After broncoscopy, ensure
8:34:41the gag reflex returns before allowing
8:34:43the patient to eat or drink, usually
8:34:45around 2 hours after the procedure. Mild
8:34:48blood tinged sputum, sore throat, or a
8:34:50dry cough may occur normally. Monitor
8:34:52closely for complications like broncos
8:34:54spasm or airway obstruction which
8:34:56present with difficulty breathing,
8:34:58wheezing or strider. These require
8:35:00immediate intervention. Now
8:35:01thorosentesis is a procedure done to
8:35:04remove fluid from the plural space,
8:35:06diagnose plural eusions or instill
8:35:08medications. Before the procedure,
8:35:10position the patient upright with arms
8:35:12supported on a bedside table and
8:35:14encourage them to remain still. After
8:35:16thorosentesis, monitor respiratory
8:35:18status hourly for the first few hours.
8:35:20It's essential to limit fluid removal to
8:35:22no more than one liter per session to
8:35:24avoid cardiovascular collapse. Watch for
8:35:27complications such as pneumathorax which
8:35:29involves symptoms like tracheal
8:35:30deviation, uneven chest movement, air
8:35:33hunger, rapid heartbeat and shallow
8:35:34respirations. Also look out for signs of
8:35:37internal bleeding including low blood
8:35:39pressure and rapid heart rate and
8:35:41mediainal shift. A dangerous
8:35:43displacement of thoracic structures.
8:35:46Chest tubes are essential devices used
8:35:48in healthcare to drain air, blood or
8:35:50fluid from the plural space, especially
8:35:52in conditions such as pneumthorax,
8:35:54meaning air in the plural space, and
8:35:56hemoththorax, meaning blood in the
8:35:58plural space. When placing a chest tube,
8:36:01the positioning depends on what's being
8:36:02drained. For numoththorax, the tube's
8:36:05tip should be directed upward, pointing
8:36:06toward the shoulder, because air
8:36:08naturally rises. In cases of
8:36:09hemoththorax or plural eusion, the tip
8:36:12should point downward toward the
8:36:13posterior chest since fluid tends to
8:36:15settle at the bottom. Now let's discuss
8:36:17the chest tube drainage system. The
8:36:19first part is called the water seal
8:36:20chamber which prevents air from flowing
8:36:22back into the plural space. It's normal
8:36:25to see slight movement of water here
8:36:27known as tidling. However, continuous
8:36:30bubbling is not normal and indicates an
8:36:32air leak which must be investigated
8:36:34immediately. The second part of the
8:36:36drainage system is the suction control
8:36:39chamber which maintains negative
8:36:41pressure inside the chest. The most
8:36:43common negative pressure setting is
8:36:44minus 20 cm of water. Gentle bubbling in
8:36:48this chamber is expected and normal with
8:36:50wet suction. As nurses, there are
8:36:52important responsibilities to follow
8:36:54when managing a patient with a chest
8:36:55tube. Encourage the patient to cough and
8:36:58deep breathe every 2 hours.
8:37:00Additionally, check the water seal level
8:37:01every 2 hours and add sterile water if
8:37:04needed. Drainage should be monitored
8:37:06closely every hour for the first 24
8:37:08hours and then every 8 hours afterward.
8:37:11If the drainage exceeds 70 ml per hour,
8:37:14notify the health care provider
8:37:16immediately. For optimal lung expansion,
8:37:18keep the patient in a semifers or high
8:37:20fowlers position. Always keep emergency
8:37:23supplies at the bedside including heist,
8:37:26sterile water, and an olusive dressing.
8:37:29In case of emergencies, if the chest
8:37:30tube becomes accidentally dislodged,
8:37:32apply an olusive dressing taped on three
8:37:34sides immediately to prevent attention
8:37:36pumothorax.
8:37:38If the drainage system becomes
8:37:40compromised, immerse the tube's tip in
8:37:41sterile water to maintain the seal.
8:37:43Signs of attention pumothorax include
8:37:46tracheal deviation, absent breath
8:37:48sounds, respiratory distress, and chest
8:37:50asymmetry. This condition requires
8:37:53immediate intervention. When removing a
8:37:55chest tube, instruct the patient to take
8:37:57a deep breath, exhale, and then bear
8:38:00down. After removal, quickly apply an
8:38:02airtight, sterile petroleum jelly gauze
8:38:04dressing and monitor closely for signs
8:38:06of respiratory distress. Now, let's go
8:38:09through some Enclelex practice
8:38:10questions. First question, a nurse is
8:38:13preparing to obtain an arterial blood
8:38:15gas or ABG sample from a patient's
8:38:18radial artery. What action should the
8:38:20nurse take first? A. Clean the puncture
8:38:23site with an antiseptic solution. B.
8:38:25Assess for a history of bleeding
8:38:27disorders. C. Perform the Allen's test.
8:38:29D. Apply pressure for at least 5 minutes
8:38:32after the procedure. The correct answer
8:38:34is option C. Perform the Allen's test.
8:38:36Second question. A nurse is caring for a
8:38:39patient who just had an arterial blood
8:38:41gas drawn. The patient suddenly develops
8:38:43shortness of breath, chest pain, and
8:38:45anxiety. Which action should the nurse
8:38:47take first? A. Notify the healthcare
8:38:49provider. B. Place the patient in
8:38:52trendberg position on the left side. C.
8:38:54Administer oxygen via nasal canula. D.
8:38:58Apply pressure to the puncture site. The
8:39:00correct answer is option B. Place the
8:39:02patient in trendenburgg position on the
8:39:04left side. Third question. A nurse is
8:39:07giving pre-procedure instructions to a
8:39:08patient scheduled for a broncoscopy.
8:39:11Which statement by the patient indicates
8:39:13a need for further teaching? A. I should
8:39:16avoid eating or drinking for 8 hours
8:39:18before the procedure. B. I may receive a
8:39:21local anesthetic to numb my throat. C. I
8:39:24should lie flat for the procedure to
8:39:26prevent complications.
8:39:28D. I might have a sore throat and blood
8:39:30tinged sputum afterward. The correct
8:39:32answer is option C. I should lie flat
8:39:35for the procedure to prevent
8:39:36complications.
8:39:38Fourth question. A nurse is monitoring a
8:39:40patient after a broncoscopy. Which
8:39:42finding requires immediate intervention?
8:39:44A. Mild sore throat. B. Blood tinged
8:39:48sputum. C. Absence of gag reflex 2 hours
8:39:51after the procedure. Dry cough. The
8:39:54correct answer is option C. Absence of
8:39:56gag reflex 2 hours after the procedure.
8:39:59Fifth question. A patient develops
8:40:01sudden shortness of breath and rapid
8:40:02heart rate after a thorosentesis. Upon
8:40:05oscultation, the nurse finds absent
8:40:06breath sounds on one side. What
8:40:09complication should the nurse suspect?
8:40:11A. Medastinal shift. B. Pumothorax. C.
8:40:16Pulmonary embism. D. Plural eusion. The
8:40:19correct answer is option B. Pumothorax.
8:40:22Sixth question. A nurse is caring for a
8:40:25patient with a newly inserted chest tube
8:40:26for hemoththorax. Which finding should
8:40:28the nurse report immediately? A. Gentle
8:40:31bubbling in the suction control chamber.
8:40:33B. Fluctuation or titling in the water
8:40:35seal chamber? C. Continuous bubbling in
8:40:38the water seal chamber. D. Drainage of
8:40:4040 ml per hour. The correct answer is
8:40:44option C. Continuous bubbling in the
8:40:46water seal chamber. Seventh question. A
8:40:48nurse notices a patient's chest tube has
8:40:51accidentally dislodged. What's the
8:40:53priority nursing action? A. Cover the
8:40:56insertion site with an occlusive
8:40:57dressing taped on three sides. B. Clamp
8:41:01the remaining chest tube to prevent air
8:41:02entry. C. Reinsert the chest tube using
8:41:05sterile technique. D. Place the patient
8:41:08in the prone position. The correct
8:41:09answer is option A. Cover the insertion
8:41:11site with an occlusive dressing taped on
8:41:13three sides. Now we will discuss oxygen
8:41:16therapy and mechanical ventilation.
8:41:18Understanding different oxygen delivery
8:41:20system signs of hypoxia and safety
8:41:22measures is crucial for nurses caring
8:41:24for patients requiring oxygen support.
8:41:27Let's start with the oxygen delivery
8:41:28systems. The first type is the nasal
8:41:30canula which provides a flow rate of 1
8:41:32to 6 L per minute and delivers 24 to 44%
8:41:36fraction of inspired oxygen. It is ideal
8:41:39for patients who have mild hypoxia or
8:41:41chronic lung disease. Nursing
8:41:43responsibilities for a nasal canula
8:41:45include checking the skin around the
8:41:46ears and nostrils for breakdown, making
8:41:49sure the prongs are positioned
8:41:50correctly, and using humidification if
8:41:52the flow rate is 4 L per minute or
8:41:55higher to prevent mucosal dryness. The
8:41:57second system is the simple face mask,
8:41:59delivering oxygen at a flow rate of 5 to
8:42:028 L per minute, providing 40 to 60%
8:42:05fraction of inspired oxygen. This mask
8:42:08is generally used for short-term oxygen
8:42:10therapy. Nurses must ensure a snug fit
8:42:13to prevent room air from diluting the
8:42:14oxygen and should remove the mask every
8:42:171 to two hours to dry the skin and avoid
8:42:19irritation. The third type is the
8:42:21partial rebreather mask providing a flow
8:42:23rate of 6 to 11 L per minute delivering
8:42:2660 to 75% fraction of inspired oxygen.
8:42:29The important point here is to never let
8:42:31the reservoir bag deflate completely.
8:42:34Nursing responsibilities include
8:42:35adjusting the oxygen flow to maintain
8:42:37inflation of the reservoir bag and
8:42:39monitoring closely for signs of carbon
8:42:40dioxide retention. The fourth device is
8:42:43the non-rebreather mask, offering the
8:42:45highest concentration of oxygen at a
8:42:46flow rate of 10 to 15 L per minute,
8:42:49delivering 80 to 95% fraction of
8:42:52inspired oxygen. It's used for severe
8:42:55hypoxia and emergency situations. Nurses
8:42:58must ensure that the reservoir bag
8:42:59remains at least 2/3 full during each
8:43:02inhalation and should perform hourly
8:43:04checks on the mask's valve and flap for
8:43:06proper function. The fifth type is the
8:43:09ventry mask, which provides the most
8:43:10precise control of oxygen concentration,
8:43:13ranging from 24 to 50% fraction of
8:43:15inspired oxygen. The flow rate varies
8:43:17based on the adapter used. It's
8:43:19especially beneficial for patients with
8:43:20chronic obstructive pulmonary disease
8:43:22who require a fixed low fraction of
8:43:24inspired oxygen to prevent carbon
8:43:26dioxide retention. Nurses should monitor
8:43:29for a proper fit and verify that the
8:43:31correct flow rate adapter is selected.
8:43:33The sixth type includes the aerosol mask
8:43:35or face tent, usually used for patients
8:43:37with facial injuries, burns, or those
8:43:38having a tracheosttomy. These devices
8:43:41deliver oxygen with high humidity.
8:43:43Nursing responsibilities involve
8:43:45frequent checks for moisture buildup and
8:43:47ensuring good skin integrity. Now, let's
8:43:49discuss the signs of hypoxia, which is
8:43:51oxygen deficiency in tissues. It is
8:43:54critical for nurses to recognize these
8:43:56signs early. Early signs of hypoxia
8:43:59include rapid breathing also called
8:44:01tachhypnia, increased heart rate known
8:44:04as tacocardia, restlessness or anxiety,
8:44:07pale skin and mucous membranes, elevated
8:44:10blood pressure, hypertension, use of
8:44:12accessory muscles during breathing,
8:44:14nasal flaring and abnormal lung sounds.
8:44:17If hypoxia is not addressed promptly, it
8:44:19progresses to late signs including
8:44:21confusion, stuper, bluish discoloration
8:44:23of skin and mucous membranes called
8:44:25cyanosis. slow breathing known as
8:44:28bradypnia, decreased heart rate, brady
8:44:30cardia, low blood pressure, hypotension,
8:44:33and abnormal heart rhythms or cardiac
8:44:35dysriythmias. Lastly, let's talk about
8:44:38oxygen toxicity and safety
8:44:39considerations. Signs of oxygen toxicity
8:44:42include a non-productive cough, pain
8:44:44beneath the sternum, subternal pain,
8:44:46nasal congestion, nausea or vomiting,
8:44:49headache, sore throat, and in severe
8:44:51cases, decreased breathing rate,
8:44:53hypoventilation.
8:44:55To prevent oxygen toxicity, nurses
8:44:57should always administer oxygen at the
8:44:59lowest effective concentration and
8:45:01carefully monitor patients, especially
8:45:03those on mechanical ventilation for
8:45:05signs of toxicity.
8:45:07General oxygen safety precautions
8:45:09include keeping oxygen sources away from
8:45:11open flames. So, absolutely no smoking
8:45:13near oxygen and using cotton clothing
8:45:15instead of wool or synthetic fabrics,
8:45:18which can create static electricity.
8:45:20It's also important to avoid using
8:45:22volatile or flammable materials like
8:45:24alcohol or petroleum based products near
8:45:26oxygen. Let's now discuss non-invasive
8:45:30ventilation which is commonly used to
8:45:32assist patients with breathing
8:45:33difficulties. The first type is called
8:45:35continuous positive airway pressure.
8:45:38This is often used for conditions such
8:45:39as obstructive sleep apnea. Continuous
8:45:41positive airway pressure works by
8:45:43continuously providing positive air
8:45:45pressure, keeping the airways open. As a
8:45:48nurse, your main responsibilities with
8:45:50continuous positive airway pressure
8:45:52include ensuring that the patient's mask
8:45:53has a proper seal. Additionally, monitor
8:45:57the patient regularly for any skin
8:45:58breakdown or dryness caused by the mask.
8:46:01Another type of NIV is called Ble
8:46:03positive airway pressure or BiPAP. This
8:46:06therapy is used for conditions like
8:46:07sleep apneoa, respiratory failure, or as
8:46:10a step before or after using a
8:46:12mechanical ventilator.
8:46:14BiPAP is unique because it provides
8:46:16different air pressures during
8:46:18inhalation and exhalation. With BiPAP,
8:46:20your nursing responsibilities include
8:46:22regularly assessing the patients
8:46:24respiratory effort and oxygen saturation
8:46:26levels. Providing frequent oral care is
8:46:28also important to maintain patient
8:46:30comfort and prevent infections.
8:46:33Moving on to mechanical ventilation,
8:46:34let's first talk about preparing a
8:46:36patient for this procedure. Before
8:46:38intubation, you must suction the airway
8:46:41thoroughly to remove any secretions.
8:46:43Make sure a manual resuscitation bag
8:46:45with a face mask and oxygen is readily
8:46:48available in case it's needed. Regular
8:46:51oral and skin care is critical during
8:46:53ventilation to prevent complications
8:46:55such as ventilator associated pneumonia.
8:46:58After the patient is extated or after
8:47:00removing the breathing tube, your care
8:47:02continues. You should encourage the
8:47:04patient to cough and practice deep
8:47:06breathing exercises. Immediately after
8:47:09extation, monitor their oxygen
8:47:11saturation and vital signs every 5
8:47:13minutes. Keep the patient positioned in
8:47:15semifers's position to help prevent
8:47:17aspiration and encourage them to use
8:47:19incentive sperometry which promotes lung
8:47:22expansion. Always monitor for signs of
8:47:24airway obstruction such as noisy
8:47:26breathing known as strider or signs of
8:47:28respiratory distress. Now let's address
8:47:30common ventilator alarms and how to
8:47:32handle them effectively. First is the
8:47:34low pressure alarm. This alarm usually
8:47:37indicates issues like disconnection, a
8:47:39leak in the cuff, or displacement of the
8:47:41breathing tube. When this alarm sounds,
8:47:44your responsibilities are to quickly
8:47:45check the ventilator tubing for any
8:47:47disconnections, reinflate the cuff if it
8:47:49has a leak, and make sure all
8:47:51connections in the ventilator circuit
8:47:52are secure. Next is the high-pressure
8:47:55alarm, which can be triggered by excess
8:47:57secretions, a kinkedked tube, the
8:47:59patient biting the tube, coughing,
8:48:00pulmonary edema, bronco spasm, or even a
8:48:03collapsed lung known as pneumothorax.
8:48:06When the high pressure alarm goes off,
8:48:07you should immediately suction
8:48:08secretions if needed. Check for any
8:48:10kinks in the tubing and assess if the
8:48:12patient is biting the tube, as sedation
8:48:14might sometimes be required. Also,
8:48:16closely monitor the patient for signs of
8:48:18pneumathorax and notify the healthcare
8:48:20provider promptly if you suspect this
8:48:21complication. A helpful pneummonic to
8:48:24remember ventilator alarms easily is
8:48:26high equals kink, low equals leak.
8:48:29Finally, let's quickly review important
8:48:31focus areas for nursing responsibilities
8:48:33on the enclelex exam related to
8:48:34oxygenation and ventilation. Recognize
8:48:37early versus late signs of hypoxia.
8:48:40Ensure precise oxygen delivery,
8:48:42especially when using devices like a
8:48:43Venturi mask. Follow strict oxygen
8:48:46safety precautions, including
8:48:48prohibiting smoking and encouraging
8:48:49patients to wear cotton clothing to
8:48:51reduce fire risk. Prevent oxygen
8:48:53toxicity by carefully monitoring oxygen
8:48:55therapy. Recognize and effectively
8:48:57respond to ventilator alarms
8:48:58immediately. Provide thorough
8:49:00post-extubation care to prevent
8:49:02complications.
8:49:04Now, let's discuss rhinitis and
8:49:06sinocitis. Rhinitis refers to the
8:49:09inflammation of the nasal mucosa causing
8:49:11symptoms such as a runny nose,
8:49:12congestion, sneezing, and nasal itching.
8:49:16This condition can be triggered by
8:49:17various factors including viral or
8:49:19bacterial infections, allergens,
8:49:21irritants, or environmental conditions.
8:49:24Effective management includes increasing
8:49:26fluid intake, using a humidifier to
8:49:28maintain moisture, practicing proper
8:49:30cough etiquette by coughing into your
8:49:31shoulder, and maintaining good hand
8:49:33hygiene. Additionally, medications such
8:49:35as antihistamines like loratine,
8:49:38decongestants such as pseudoedrin and
8:49:40intraasal corticosteroids like
8:49:42fluticosone are helpful in managing
8:49:44symptoms.
8:49:46Sinocitis is similar to rhinitis but it
8:49:48specifically involves inflammation of
8:49:50the sinuses. If sinocitis is caused by
8:49:53bacteria, antibiotics like amoxicylin
8:49:56are typically used. Other effective
8:49:58treatments include nasal irrigation,
8:49:59decongestants, and pain relievers. As
8:50:02nurses, it's important to educate
8:50:04patients on nasal irrigation techniques,
8:50:06encourage increased hydration and
8:50:08humidified air use, and closely monitor
8:50:11for potential complications such as
8:50:12sinus infections. Next, let's move on to
8:50:15influenza. Influenza, commonly known as
8:50:18the flu, is a highly contagious viral
8:50:20infection that presents with severe
8:50:21headaches, muscle aches, fever, chills,
8:50:24fatigue, nausea, vomiting, and diarrhea.
8:50:28Treatment involves antiviral medications
8:50:30like Oeltomir, which must be started
8:50:32within 24 to 48 hours after symptoms
8:50:35appear to be effective. Supportive care,
8:50:38including rest, proper hydration, and
8:50:40treating symptoms individually, is also
8:50:42essential. To prevent influenza, an
8:50:44annual flu vaccination is recommended
8:50:46for everyone older than 6 months.
8:50:48Nursing responsibilities include
8:50:49educating patients about the importance
8:50:51of vaccination, monitoring for
8:50:53complications such as pneumonia, and
8:50:55implementing droplet precautions to
8:50:57prevent spread. Now, we'll discuss
8:50:59pneumonia. Pneumonia is an infection
8:51:01that causes inflammation of the alvioli
8:51:03leading to fluid accumulation in the
8:51:05lungs. Common symptoms include fever,
8:51:07chills, cough, either productive or
8:51:10non-productive, shortness of breath,
8:51:12chest pain, crackles, wheezing, and
8:51:14confusion in elderly patients. Diagnosis
8:51:17is confirmed through a chest X-ray
8:51:19showing lung consolidation, sputum
8:51:21cultures collected before starting
8:51:22antibiotics, and pulse occimmetry
8:51:24readings below 95% indicating hypoxia.
8:51:28Treatment involves positioning the
8:51:29patient in a high fowler's position,
8:51:31sitting upright at 90°, encouraging
8:51:34coughing, deep breathing, and the use of
8:51:36an incentive sperometer. Oxygen therapy
8:51:39may be required along with increased
8:51:41calorie and fluid intake of 2 to 3 L per
8:51:43day. Medications typically used include
8:51:46antibiotics like a zithramycin for
8:51:48bacterial pneumonia, broncoilators such
8:51:50as albuterol and anti-inflammatory drugs
8:51:53like predinosone. Nurses must monitor
8:51:56for worsening symptoms and signs of
8:51:57sepsis, assess response to antibiotics,
8:52:00educate patients on pneumonia
8:52:02vaccination, pneumovax for high- risk
8:52:04groups, and watch for side effects of
8:52:06corticosteroids such as gastrointestinal
8:52:08bleeding and high blood sugar levels
8:52:10levels. Hey future nurses, listen up. If
8:52:12you want to pass the Anklex in one try,
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8:52:52today. Moving forward to asthma, which
8:52:55is a chronic inflammatory disorder that
8:52:57causes intermittent and reversible
8:52:58airway obstruction. Symptoms include
8:53:01wheezing, coughing, prolonged
8:53:03exhalation, decreased oxygen saturation,
8:53:05and in chronic cases, a barrel-shaped
8:53:08chest. Asthma is diagnosed through
8:53:10pulmonary function tests and using a
8:53:11peak flow meter noting the highest of
8:53:13three readings. Treatment includes
8:53:16placing the patient in a high fowler's
8:53:17position, administering oxygen therapy,
8:53:19and using medications like short acting
8:53:21betaagonists such as albuterol for acute
8:53:24attacks, antiolinergics likeropium for
8:53:27maintenance, theophilene monitoring for
8:53:29toxicity, long acting betaagonists like
8:53:32salmearol for prevention, and
8:53:34anti-inflammatory medications like
8:53:36gluccocorticoids and lucatrine
8:53:38antagonists. In emergencies such as
8:53:41status asthmaticus, a severe asthma
8:53:43attack unresponsive to standard
8:53:45treatment. Immediate administration of
8:53:46oxygen bronco dilators and possibly
8:53:48epinephrine is essential. Nursing
8:53:51responsibilities include teaching proper
8:53:52inhaler techniques using a spacer with
8:53:55steroids to prevent oral thrush.
8:53:57Monitoring medication side effects and
8:53:58educating patients on asthma triggers
8:54:00and prevention strategies. Finally,
8:54:03let's discuss chronic obstructive
8:54:04pulmonary disease, also known as COPD.
8:54:08COPD is a progressive irreversible lung
8:54:10disease divided into two main
8:54:12categories. Emphyma characterized by
8:54:15loss of lung elasticity and destruction
8:54:17of alvioli causing carbon dioxide
8:54:19retention and chronic bronchitis
8:54:21characterized by inflammation of bronkey
8:54:23with excessive mucus production. Risk
8:54:26factors include smoking, environmental
8:54:28exposure, aging and genetic factors such
8:54:30as alpha 1 antitrien deficiency.
8:54:33Symptoms typically include shortness of
8:54:34breath, wheezing, accessory muscle use
8:54:36during breathing, barrel chest, clubbing
8:54:39of fingers, low oxygen levels less than
8:54:4180 millime of mercury, and high carbon
8:54:44dioxide levels greater than 45 mm of
8:54:47mercury. Dependent edema may also occur
8:54:49due to right-sided heart failure
8:54:51associated with pulmonary hypertension.
8:54:53COPD is diagnosed using pulmonary
8:54:54function tests, arterial blood gas
8:54:56analysis indicating respiratory
8:54:58acidosis, and chest X-rays showing
8:55:00hyperinflated lungs. Treatment includes
8:55:02maintaining the patient in a high
8:55:04fowler's position, encouraging ped lip
8:55:06and diaphragmatic breathing, providing
8:55:08lowflow oxygen therapy to prevent
8:55:10excessive carbon dioxide retention, and
8:55:12recommending a high calorie high protein
8:55:15diet. Medications include broncoilators
8:55:18like albuterol andropium, theophilene
8:55:20with careful monitoring for toxicity,
8:55:22mucalytics such as acetylcyine, and
8:55:25corticosteroids watching for side
8:55:27effects like high blood sugar and fluid
8:55:29retention. Nurses must monitor for
8:55:31frequent respiratory infection, signs of
8:55:33right-sided heart failure, core
8:55:35pulmonal, educate patients on breathing
8:55:37techniques, encourage smoking sessation,
8:55:39and teach early recognition of infection
8:55:41through symptoms like increased sputum
8:55:43or fever. Monitoring for signs of carbon
8:55:46dioxide retention such as confusion or
8:55:48drowsiness is also crucial. Now, we'll
8:55:51practice some important enclelex
8:55:53questions related to patient education
8:55:55and disease management. The first
8:55:57question is a nurse is providing
8:55:59education to a patient who has rhinitis
8:56:01which means inflammation of the nasal
8:56:03passages about managing their symptoms.
8:56:05Which statement made by the patient
8:56:07shows that they need further teaching?
8:56:09Option A says I will increase my fluid
8:56:12intake to help with congestion. Option B
8:56:14says using a humidifier can help relieve
8:56:16nasal irritation. Option C says I should
8:56:19take my antibiotics as prescribed to
8:56:21treat the viral infection. Option D says
8:56:25practicing hand hygiene can help prevent
8:56:27the spread of infection. The correct
8:56:28answer here is option C. This is because
8:56:31rhinitis caused by viruses doesn't
8:56:33require antibiotics. Antibiotics are
8:56:36used only for bacterial infections.
8:56:38Drinking more fluids using a humidifier
8:56:40and washing hands are all appropriate
8:56:43ways to manage rhinitis. Moving to
8:56:46question two. The nurse is assessing a
8:56:48patient who might have bacterial
8:56:49sinusitis. An infection of the sinuses
8:56:52caused by bacteria. Which symptom most
8:56:55strongly indicates bacterial sinusitis?
8:56:58Option A mentions clear nasal drainage
8:57:00and sneezing. Option B describes
8:57:02purilent nasal discharge meaning thick
8:57:05yellow or green mucus along with facial
8:57:07pain. Option C states dry cough and mild
8:57:11sore throat. Option D includes nasal
8:57:14congestion and post-nasal drip. The
8:57:16correct answer is option B. Purulent
8:57:18nasal discharge along with facial pain
8:57:20strongly suggests bacterial sinusitis.
8:57:23Clear drainage and sneezing typically
8:57:24point towards allergies. Dry cough and
8:57:27mild sore throat are general symptoms
8:57:29not specific enough for bacterial
8:57:30sinusitis. Now question three. A nurse
8:57:34is caring for a patient diagnosed with
8:57:36pneumonia. What's the highest priority
8:57:38nursing intervention in this case?
8:57:40Option A says encouraging the patient to
8:57:42drink 2 to three L of fluids each day.
8:57:45Option B involves giving broncoilators
8:57:48medications that help open airways.
8:57:51Option C mentions placing the patient in
8:57:53high fowler's position, meaning sitting
8:57:55them upright. Option D suggests
8:57:58obtaining a sputum culture before
8:58:00starting antibiotics. The correct answer
8:58:02is option D. Taking a sputum sample
8:58:05before starting antibiotics is crucial
8:58:07because it ensures the right antibiotic
8:58:09is chosen for effective treatment. While
8:58:12the other interventions are important,
8:58:13they do not come before identifying the
8:58:15correct antibiotic. Next, we'll talk
8:58:17about tuberculosis commonly called TB.
8:58:22Tuberculosis is a highly contagious
8:58:23disease caused by the bacteria
8:58:25mcoacterium tuberculosis. It mainly
8:58:28affects the lungs but can spread to
8:58:29other parts of the body which is called
8:58:31extraulmonary TB. TB spreads through
8:58:34airborne droplets when an infected
8:58:35person coughs, sneezes or speaks.
8:58:38Therefore, special precautions are
8:58:39necessary. Patients should stay in a
8:58:41negative pressure isolation room.
8:58:44Healthare workers must wear an N95
8:58:46respirator mask. The patient must wear a
8:58:49surgical mask whenever they leave their
8:58:50room. Certain factors increase the risk
8:58:52of getting TB. Crowded environments like
8:58:55prisons, homeless shelters, and nursing
8:58:57homes. Poor socioeconomic conditions
8:59:00such as low-income, malnutrition, and
8:59:01limited healthcare access. Health issues
8:59:04that weaken the immune system like HIV,
8:59:06chemotherapy, organ transplants, and
8:59:08diabetes. substance abuse, including
8:59:11alcoholism and introvenous drug use.
8:59:14Recognizing TB symptoms can be
8:59:15remembered with the phrase TB coughs and
8:59:17sweats, persistent cough lasting more
8:59:20than 3 weeks, producing mucus that can
8:59:22be bloody or purilent containing pus,
8:59:25unexplained and significant weight loss,
8:59:28extreme fatigue and lethargy, loss of
8:59:30appetite, also known as anorexia, night
8:59:33sweats, and a low-grade fever.
8:59:35Diagnosing TB involves the tubercculin
8:59:38skin test, also called the mantto test.
8:59:41An induration or raised area of 10 mm or
8:59:44greater is positive for most people and
8:59:465 mm or greater is positive for
8:59:48imunocmpromised patients. A previous BCG
8:59:51vaccine can cause false positives,
8:59:53requiring a chest X-ray for
8:59:55confirmation. Chest X-rays help identify
8:59:57active TB lesions. Sputum cultures,
9:00:00specifically an acidfast basili test,
9:00:02need three early morning sputum samples
9:00:04collected on different days. Treatment
9:00:07usually involves ripe therapy for 6 to
9:00:0912 months consisting of ref ampun which
9:00:12can affect the liver and causes orange
9:00:14red discoloration of bodily fluids like
9:00:16urine, sweat and tears. It may even
9:00:18stain contact lenses. Isaniazid also
9:00:21affecting the liver and causing
9:00:22peripheral neuropathy, nerve damage.
9:00:25Vitamin B6 or pyodoxine can prevent
9:00:28this. Pyroinomide, another liver
9:00:30affecting drug that can cause gout. So
9:00:32patients should drink plenty of fluids.
9:00:34Ethamatl known to affect vision leading
9:00:36to color blindness or changes in
9:00:38eyesight requiring regular eye checkups.
9:00:41Streptoycin, an alternative medication
9:00:43that can cause hearing damage. Thus,
9:00:45hearing checks are essential. Nurses
9:00:47must also ensure regular sputum cultures
9:00:49every 2 to 4 weeks until three
9:00:50consecutive negative cultures confirm
9:00:52the patient is no longer infectious.
9:00:54It's critical to maintain medication
9:00:55adherence to prevent drugresistant TB.
9:00:58Sometimes directly observed therapy or
9:01:00DOT is required to ensure compliance.
9:01:03Since TB is a reportable disease, health
9:01:05care providers must notify local health
9:01:07authorities. Educating the patient is
9:01:09key, emphasizing avoiding alcohol to
9:01:12protect the liver, practicing good cough
9:01:14hygiene by covering the mouth, and
9:01:15safely disposing of tissues, and
9:01:17ensuring household contacts are screened
9:01:19for TB. Now we will discuss myiocardial
9:01:23infarction and perccutaneous coronary
9:01:25intervention essential concepts in
9:01:27cardiac care. Perccutaneous coronary
9:01:30intervention known as PCI aims to open
9:01:33blocked coronary arteries. Methods used
9:01:35include balloon angoplasty placing
9:01:38stances or removing plaque. This
9:01:41procedure must be performed within 90
9:01:43minutes after symptoms of myioardial
9:01:45inffection appear.
9:01:47Typical signs of a moardial inffection,
9:01:49also called a heart attack, include
9:01:51crushing chest pain that may radiate to
9:01:53the jaw, left arm, or shoulder. However,
9:01:56some patients, especially women, may
9:01:58show atypical symptoms like nausea,
9:02:00excessive sweating known as diapharesis,
9:02:03shortness of breath or fatigue.
9:02:05There are two main types of myioardial
9:02:07inffection. STEMI and an STEMI. STEMI
9:02:10stands for ST segment elevation
9:02:12mocardial infarction which appears on an
9:02:14electroc cardiogram as ST elevation and
9:02:18is more dangerous and STEMI means nonST
9:02:20elevation. Myioardial inffection
9:02:23appearing as ST depression or inverted
9:02:25T- waves. As a nurse caring for patients
9:02:28undergoing PCI, your responsibilities
9:02:30begin before the procedure. The patient
9:02:32must remain without food or drink for 8
9:02:34hours. It's important to assess for
9:02:36allergies to shellfish or iodine as
9:02:38these indicate a possible allergy to
9:02:40contrast dye. Monitoring kidney function
9:02:42is also necessary since the kidneys
9:02:44excrete the dye. After the PCI
9:02:47procedure, carefully monitor the groin
9:02:48site for bleeding. Regularly check pedal
9:02:50pulses to ensure good blood circulation
9:02:52in the feet. Keep the patient flat and
9:02:55on bed rest for 4 to 6 hours. Administer
9:02:58medications like antiplatelet or
9:03:00thrombolytic agents and encourage
9:03:01introvenous fluids to help flush out the
9:03:03contrast die. Advise patients to avoid
9:03:06strenuous activities and heavy lifting.
9:03:09Continuously monitor for signs of
9:03:11internal bleeding such as low blood
9:03:12pressure or a rapid heart rate. One
9:03:14serious complication after PCI is
9:03:16cardiac tampenade a medical emergency.
9:03:19Signs include low blood pressure,
9:03:21distended neck veins known as jugular
9:03:23vein distension, muffled heart sounds,
9:03:25and paradoxical pulse. Next we will
9:03:27discuss coronary artery bypass graft
9:03:30commonly called cabg a surgical
9:03:32procedure used to bypass blocked
9:03:34coronary arteries. Surgeons typically
9:03:36use the saphinous vein from the leg or
9:03:38the internal mammary artery from the
9:03:40chest. After surgery encourage patients
9:03:43to perform coughing and deep breathing
9:03:45exercises to prevent pneumonia and teach
9:03:47them to use an incentive sperometer.
9:03:50Initially patients may have an
9:03:51endotracheial tube and require
9:03:53mechanical ventilation. Monitor surgical
9:03:55incisions in the chest and leg carefully
9:03:57for signs of infection. Closely observe
9:03:59chest tube drainage. More than 150
9:04:02milliliters per hour could indicate
9:04:03bleeding and you must notify the
9:04:05healthcare provider immediately.
9:04:07Maintain a low core body temperature
9:04:09postoperatively to reduce oxygen
9:04:11demands. Educate patients about
9:04:13necessary lifestyle changes including
9:04:15diet, exercise, and smoking sessation.
9:04:18Now we will discuss peripheral artery
9:04:21disease, a condition restricting blood
9:04:22flow to the extremities. Patients
9:04:24typically experience intermittent
9:04:26claudication, which is pain during
9:04:29exercise that resolves with rest.
9:04:30Another sign is rest pain relieved by
9:04:33lowering the legs below heart level.
9:04:35Additional symptoms include absent or
9:04:37weak pulses, cold, shiny, hairless skin,
9:04:41and feet that appear modeled or dusky
9:04:43with thickened toenails. For peripheral
9:04:45bypass graphs, your responsibilities as
9:04:47a nurse include pre-operative fasting
9:04:49for eight hours. Post-operatively,
9:04:52instruct patients not to cross their
9:04:54legs to prevent blockage. Frequently
9:04:56check pulses, skin color, temperature,
9:04:58and capillary refill in the feet.
9:05:00Maintain strict bed rest for 18 to 24
9:05:03hours with legs kept straight and apply
9:05:05compression stockings. Be alert for
9:05:07complications such as compartment
9:05:09syndrome, which is a medical emergency.
9:05:11Look for the five Ps. Pain,
9:05:13pulselessness, paristhesia or tingling
9:05:15sensation, paralysis and palar.
9:05:18Immediate treatment with a surgical
9:05:20fasciottomy is required to relieve the
9:05:22pressure. Finally, let's discuss angina
9:05:24and myioardial inffection. Two
9:05:26conditions involving reduced blood flow
9:05:27to the heart. Angina can be stable
9:05:30occurring during exercise and relieved
9:05:32by rest or nitroglycerin. unstable,
9:05:34occurring even at rest and progressively
9:05:37worsening or variant caused by coronary
9:05:40artery spasms that happen at rest.
9:05:42Symptoms of a myioardial inffection
9:05:44typically last longer than 30 minutes,
9:05:46distinguishing them from angina.
9:05:49Patients often experience shortness of
9:05:50breath, heavy sweating, feelings of
9:05:52impending doom, cool, clammy skin, and
9:05:55rapid heart rate. Risk factors include
9:05:58being male or a post-menopausal female,
9:06:00high blood pressure, smoking, high
9:06:02cholesterol, diabetes, and stress. On an
9:06:05electroc cardiogram, a STEMI shows ST
9:06:08elevation, whereas an NST STEMI shows ST
9:06:10depression and inverted T- waves.
9:06:13Nitroglycerin is commonly used to treat
9:06:15cardiac chest pain. Be cautious of
9:06:17orthostatic hypotension. Patients should
9:06:20stop activities, sit and rest before
9:06:22taking the medication sublingually.
9:06:25If pain persists after three doses, call
9:06:27emergency services immediately.
9:06:30Headaches are common side effects. Other
9:06:33medications include opioid pain
9:06:35relievers like morphine and beta
9:06:37blockers, which require pulse checks
9:06:39before administration. We'll discuss
9:06:41heart failure and pulmonary edema, two
9:06:44closely related conditions. Heart
9:06:46failure is a chronic condition where the
9:06:48heart becomes unable to pump blood
9:06:50effectively to meet the body's needs. We
9:06:52typically classify heart failure into
9:06:54two types based on the area of
9:06:56congestion. Right-sided heart failure
9:06:59leading to congestion in the body and
9:07:00leftsided heart failure causing
9:07:02congestion in the lungs. Let's quickly
9:07:05review how blood flows through a healthy
9:07:07heart. First, deoxxygenated blood
9:07:09returns to the right atrium, moves into
9:07:11the right ventricle, and is pumped to
9:07:13the lungs for oxygenation. Then
9:07:14oxygen-rich blood returns to the left
9:07:17atrium, moves into the left ventricle,
9:07:19and is pumped out to supply the entire
9:07:21body. In heart failure, this pumping
9:07:23action is impaired. If the left side of
9:07:25the heart fails, blood backs up into the
9:07:27lungs, causing pulmonary congestion. If
9:07:29the right side fails, blood accumulates
9:07:32in the body and causing systemic
9:07:34congestion. Now, let's understand these
9:07:36two types of heart failure separately.
9:07:38First, right-sided heart failure, also
9:07:41known as systemic congestion. Here blood
9:07:44accumulates in the body's circulation
9:07:46causing symptoms like swelling or
9:07:47peripheral edema in the legs, ankles and
9:07:50sacral area. You may also notice visibly
9:07:53distended jugular veins called jugular
9:07:55vein distension or JVD. Additionally,
9:07:58fluid can collect in the abdomen leading
9:08:00to acites or abdominal enlargement and
9:08:02the liver may enlarge. This is known as
9:08:03hpatomegaly causing pain in the right
9:08:06upper quadrant. Weight gain due to fluid
9:08:08retention is also common. Second,
9:08:10left-sided heart failure, which leads to
9:08:12pulmonary congestion. Here, blood backs
9:08:15up into the lungs, making it harder to
9:08:17breathe. Common symptoms include
9:08:18crackles in the lungs, difficulty
9:08:20breathing, known as disna, and trouble
9:08:22breathing when lying flat called
9:08:24orthopeneia.
9:08:25Pulmonary edema can develop presenting
9:08:27as pink tinged frothy sputum, which is a
9:08:29serious medical emergency. Patients
9:08:32might also experience sudden nighttime
9:08:34shortness of breath called paroxismal
9:08:36nocturnal dispnnea or PND along with
9:08:38fatigue and weakness due to decreased
9:08:40cardiac output. Moving to diagnostic
9:08:43tests and laboratory findings, we have
9:08:45specific markers to detect heart
9:08:46failure. The brainetic peptide or BNP
9:08:50level becomes elevated in heart failure.
9:08:53Normally BNP is less than 100 pogs per
9:08:56milliliter. But in heart failure levels
9:08:58typically rise above 400 pigs per
9:09:00milliliter. Ejection fraction or EF
9:09:05which measures how well the heart pumps
9:09:07is reduced from the normal range of 50
9:09:08to 70% down to below 40%. We also see
9:09:12certain hemodynamic changes. An increase
9:09:14in central venus pressure, an increase
9:09:16in pulmonary wedge pressure, elevated
9:09:18pulmonary artery pressure, and decreased
9:09:21cardiac output.
9:09:23For imaging studies, the echo cardiogram
9:09:25is considered the gold standard, helping
9:09:26assess ejection fraction and heart
9:09:28chamber function. A chest X-ray can show
9:09:31heart enlargement known as cardiomegali
9:09:33and signs of pulmonary congestion.
9:09:36Additionally, transissophageal echoc
9:09:37cardiography can provide detailed images
9:09:39of heart function. Next, let's highlight
9:09:42some critical nursing interventions that
9:09:44are high yield for enclelex. Daily
9:09:46weights are essential as they are the
9:09:48best indicator of fluid retention.
9:09:50Always report a weight gain of more than
9:09:53two pounds in 24 hours. Strict
9:09:55monitoring of intake and output helps
9:09:57manage fluid overload. Provide oxygen
9:09:59therapy to support proper oxygenation
9:10:01and position patients in high fowlers to
9:10:04improve breathing. Assisting with
9:10:07activities of daily living helps reduce
9:10:08the heart's workload. Fluid restriction
9:10:11and limiting sodium intake to less than
9:10:132 g per day are crucial to preventing
9:10:15fluid retention. Additionally, monitor
9:10:18patients for signs of dyin toxicity such
9:10:21as visual disturbances, nausea,
9:10:23vomiting, and slowed heart rate.
9:10:25Regarding medications, we have several
9:10:26important drug classes used in heart
9:10:28failure management essential for the
9:10:30enclelex exam. First, diuretics reduce
9:10:33fluid overload. Loop diuretics such as
9:10:36furosmomide or bumatonide can cause low
9:10:38potassium levels or hypocalemia leading
9:10:41to muscle cramps or arrhythmias. So
9:10:43encourage patients to eat potassium
9:10:45richch foods like bananas, oranges or
9:10:47potatoes. They also carry a risk of
9:10:49autotoxicity if given too quickly
9:10:51introvenously. Thioide diuretics like
9:10:54hydrochloroioide
9:10:56similarly risk hypocalemia and may also
9:10:59cause hypoglycemia or high blood sugar.
9:11:02Second, ACE inhibitors ending with prill
9:11:04and arbs ending with sarton reduce
9:11:07afterload easing the heart's workload.
9:11:10ACE inhibitors like leinopril and
9:11:12enalopril can cause angioadeema, dry
9:11:15cough and elevated potassium or
9:11:17hypercalemia. Always monitor blood
9:11:19pressure before administering due to a
9:11:21risk of hypotension.
9:11:23ARBs like lartin or valartin have
9:11:26similar risks but are often used as
9:11:28alternatives if the patient develops a
9:11:30cough from ACE inhibitors. Third, beta
9:11:33blockers ending with LOL reduce the
9:11:35workload of the heart. Common examples
9:11:37include metoprolol or carvidol which can
9:11:40lead to bredicardia, hypotension and
9:11:42fatigue. Always check the heart rate
9:11:44before administration holding the
9:11:46medication if the rate is below 60 beats
9:11:48per minute. Fourth, dyoxin increases
9:11:51heart muscle contractility. Always check
9:11:54the apical pulse for one full minute
9:11:56before giving dyoxin holding it if the
9:11:58pulse is below 60 beats per minute.
9:12:01Watch for signs of toxicity including
9:12:03nausea, vomiting, fatigue, muscle
9:12:04weakness, confusion, and visual
9:12:06disturbances like seeing yellow green
9:12:08halos. Remember, low potassium levels
9:12:11increase the risk of dioxin toxicity.
9:12:14Lastly, calcium channel blockers ending
9:12:16with pine such as amloipine and
9:12:19nifetapine can lead to hypotension and
9:12:21peripheral edema. Finally, let's address
9:12:24pulmonary edema, a critical medical
9:12:26emergency.
9:12:28Pulmonary edema happens when fluid
9:12:29rapidly accumulates in the lungs due to
9:12:31severe left-sided heart failure.
9:12:34Patients may show extreme difficulty
9:12:36breathing, gasping for air, crackles or
9:12:38wheezing in the lungs and cough up pink
9:12:40frothy sputum. Initially patients have
9:12:42rapid heart rate teocardia and high
9:12:45blood pressure hypertension. But this
9:12:47may quickly progress to low blood
9:12:48pressure or shock. Emergency nursing
9:12:51interventions here include immediately
9:12:53administering oxygen and placing the
9:12:55patient in high fowler's position.
9:12:57giving intravenous diuretics like
9:12:59furosomide for rapid fluid removal.
9:13:01Administering nitroglycerin to reduce
9:13:03both preload and afterload and giving
9:13:05morphine to reduce anxiety and dilate
9:13:08blood vessels to improve circulation.
9:13:10Always closely monitor arterial blood
9:13:12gases and oxygenation levels. Advanced
9:13:16interventions in cardiac care include
9:13:17placing a pacemaker which is commonly
9:13:19used to manage conduction defects in the
9:13:21heart. Another advanced intervention is
9:13:23the use of a left ventricular assist
9:13:25device specifically for patients
9:13:27experiencing severe heart failure. In
9:13:30endstage heart failure, a heart
9:13:31transplant may be the only viable
9:13:33solution. Patients undergoing a heart
9:13:35transplant will need lifelong
9:13:37immunosuppressive medications to prevent
9:13:38organ rejection. Now let's discuss some
9:13:41of the most important nursing
9:13:42responsibilities that you might
9:13:44encounter on the enclelex exam. Firstly,
9:13:47performing daily weight checks on your
9:13:48patients is crucial and you should
9:13:50immediately report if there's a weight
9:13:52gain of more than 2 lbs within 24 hours.
9:13:55Before administering cardiac medications
9:13:57such as ACE inhibitors, beta blockers,
9:13:59or digin, always monitor the patients
9:14:02blood pressure and heart rate. It is
9:14:04also essential to assess your patients
9:14:05for signs of pulmonary congestion such
9:14:07as crackles in the lungs, difficulty
9:14:09breathing, or the presence of pink
9:14:11frothy sputum.
9:14:13Monitoring electrolyte imbalances is
9:14:15vital because patients on diuretics may
9:14:17develop low potassium levels,
9:14:18hypocalemia, whereas those on ACE
9:14:21inhibitors or ARB may have elevated
9:14:23potassium levels, hypercalemia. Educate
9:14:26your patients clearly about fluid and
9:14:28sodium restrictions to help manage their
9:14:29symptoms. Always watch carefully for
9:14:32signs of deoxin toxicity, which includes
9:14:34visual changes, nausea, vomiting, and a
9:14:37slow heart rate. If your patient is
9:14:39experiencing shortness of breath,
9:14:40elevate the head of the bed and provide
9:14:42supplemental oxygen. Moving forward,
9:14:44let's talk about valvular heart disease.
9:14:46Commonly, VHD occurs when one or more
9:14:49heart valves become narrowed, known as
9:14:51stenosis, or leaky, known as
9:14:54insufficiency.
9:14:55This issue disrupts the normal flow of
9:14:57blood, impacting cardiac output and
9:14:59overall oxygenation.
9:15:01Early identification and treatment are
9:15:03critical. In terms of pathophysiology,
9:15:06remember that the heart has four valves,
9:15:08mital, aortic, trauspid and pulmonary.
9:15:11Stenosis happens when a valve stiffens
9:15:13and blocks blood flow. On the other
9:15:15hand, insufficiency or regurgitation
9:15:17occurs when a valve does not close fully
9:15:19allowing blood to flow backward.
9:15:22Valvular heart disease can have several
9:15:23causes. Infectious causes include
9:15:26rheumatic heart disease from untreated
9:15:28group A streptocockal infections,
9:15:30infective endocarditis typically caused
9:15:32by streptococcus veritins or stafylocus
9:15:34orius and rarely syphilis. Degenerative
9:15:37causes such as aging lead to fibroic
9:15:40thickening and stiffness in the valves.
9:15:42Congenital causes include conditions
9:15:44like a bicaspid aortic valve, a common
9:15:47birth defect. Systemic conditions like
9:15:49chronic high blood pressure and
9:15:51connective tissue disorders such as
9:15:52Marfin syndrome or Ellers's Danlo
9:15:54syndrome also affect valve health.
9:15:57Clinically, patients with valvular heart
9:15:59disease often present with murmurss due
9:16:01to turbulent blood flow, extra heart
9:16:02sounds like S3 and S4, or arrhythmias
9:16:06such as atrial fibrillation,
9:16:07particularly common in mital stenosis.
9:16:10Symptoms can include shortness of
9:16:11breath, fatigue, dizziness, fainting,
9:16:15and signs of pulmonary congestion like
9:16:17crackles in the lungs. Right-sided valve
9:16:20dysfunction typically leads to
9:16:21peripheral swelling or fluid
9:16:22accumulation in the abdomen as
9:16:26diagnostic tests for valvular heart
9:16:27disease include an echo cardiogram,
9:16:29which is considered the gold standard
9:16:31because it assesses valve function. A
9:16:34chest X-ray helps detect an enlarged
9:16:36heart or pulmonary congestion. An
9:16:38electroc cardiogram identifies irregular
9:16:40heart rhythms like atrial fibrillation.
9:16:43Cardiac catheterization measures
9:16:45pressure differences across heart
9:16:46valves. Medical management involves
9:16:48medications to relieve symptoms.
9:16:50Diuretics, especially loop diuretics
9:16:52like ferosomide, reduce fluid volume,
9:16:55decreasing the workload on the heart.
9:16:57Watch for side effects like low
9:16:58potassium levels. And encourage your
9:17:00patients to eat potassium richch foods
9:17:02such as potatoes, bananas, leafy greens,
9:17:04and oranges. When administering
9:17:07introvenous potassium, never exceed 20
9:17:09mill equivalents per hour. ACE
9:17:11inhibitors and ARBs help reduce
9:17:13resistance the heart pumps against and
9:17:15improve cardiac output. They may cause
9:17:17side effects like swelling, angioadeema,
9:17:19a persistent dry cough, or increased
9:17:22potassium levels. Beta blockers reduce
9:17:25the oxygen demand of the heart muscle
9:17:26and control heart rate, especially in
9:17:28atrial fibrillation. Side effects
9:17:31include a slow heart rate, low blood
9:17:33pressure, and fatigue. Calcium channel
9:17:35blockers like dilism, verapomile or
9:17:38amladopine decrease afterload and manage
9:17:40arhythmias but might cause low blood
9:17:42pressure, swelling or dizziness. Dioxin
9:17:45strengthens heart contractions and slows
9:17:46the heart rate. Be alert for dyoxin
9:17:49toxicity with symptoms like nausea,
9:17:51vomiting, visual disturbances, confusion
9:17:54and slow heart rate. Always check the
9:17:56apical pulse for one full minute before
9:17:58administering dioxin and hold the
9:18:00medication if the heart rate is below 60
9:18:02beats per minute. Procedures and
9:18:05surgical options include perccutaneous
9:18:06balloon valvulasty, a minimally invasive
9:18:09technique used to widen narrowed valves.
9:18:12Valve repair or annuloplasty may be
9:18:15possible to preserve the natural valve.
9:18:17Valve replacements can be either
9:18:19mechanical requiring lifelong
9:18:20anti-coagulation therapy with warfaren
9:18:22or bioprothetic which does not require
9:18:24anti-coagulation but typically lasts a
9:18:27shorter time. Finally, some nursing
9:18:30responsibilities frequently tested on
9:18:31the ENLEX include listening carefully
9:18:33for murmurss and noting their location
9:18:35and timing, monitoring signs of heart
9:18:37failure, such as difficulty breathing,
9:18:39crackles, and swelling, and regularly
9:18:41checking blood pressure, and heart rate.
9:18:44Educate your patients about dietary
9:18:46adjustments, including low sodium diets
9:18:48to reduce fluid retention and high
9:18:50potassium diets when on loop diuretics.
9:18:54Advise patients to avoid
9:18:55over-the-counter anids, which can
9:18:57increase fluid retention and blood
9:18:59pressure. Patients with prosthetic
9:19:01valves or repairs must have antibiotic
9:19:03prophylaxis before dental or invasive
9:19:05procedures to prevent infective
9:19:07endocarditis. After valve replacement
9:19:10surgery, monitor closely for signs of
9:19:12blood clots or bleeding complications.
9:19:14Educate patients thoroughly about
9:19:16lifelong anti-coagulation, regular INR
9:19:19monitoring, and signs of bleeding such
9:19:21as bruising, blood in the urine, or
9:19:23black stools. Be vigilant for emergency
9:19:26situations like acute pulmonary edema or
9:19:28sudden valve dysfunction postsurgery
9:19:30indicated by shortness of breath, chest
9:19:32pain, or new murmurss. Let's review some
9:19:35key enclelex points to remember. First,
9:19:37streptocoakal infections are a major
9:19:39cause of valvular heart disease,
9:19:40especially rheumatic fever and
9:19:41endocarditis. Next, distinguishing
9:19:44between systolic and diastolic murmurss
9:19:46helps differentiate valve stenosis from
9:19:48regurgitation. Also, loop diuretics
9:19:51reduce preload in the heart, but watch
9:19:53carefully for hypocalemia, meaning low
9:19:55potassium levels. On the other hand, ACE
9:19:58inhibitors help reduce afterload.
9:20:00However, monitor patients closely for
9:20:02hypercalemia, high potassium levels, and
9:20:05signs of angioadeema, which is facial or
9:20:07throat swelling. Remember mechanical
9:20:09heart valves require lifelong
9:20:11anticoagulation therapy with warferin.
9:20:14Regularly check the international
9:20:15normalized ratio or INR and keep it
9:20:18between 2.5 and 3.5. Additionally,
9:20:21patients with heart conditions must take
9:20:23antibiotic prophylaxis before undergoing
9:20:25dental or surgical procedures to prevent
9:20:27infections. Lastly, always check the
9:20:30aical pulse for one full minute before
9:20:32administering dioxin. If the pulse is
9:20:34below 60 beats per minute, hold the
9:20:36medication. Now let's discuss
9:20:39inflammatory disorders of the heart
9:20:41specifically paricarditis, rheumatic
9:20:43endocarditis and infective endocarditis.
9:20:46These disorders are frequently triggered
9:20:47by infections particularly streptocoakal
9:20:50infections and require prompt treatment
9:20:52to avoid serious complications starting
9:20:55with rheumatic endocarditis. It is
9:20:57primarily caused by group A beta
9:20:58hemolytic streptococcus infection
9:21:00typically after untreated or poorly
9:21:03treated strep throat known as
9:21:05streptococcal fngitis. In this
9:21:07condition, the body's immune response to
9:21:09the infection leads to heart
9:21:11inflammation, creating ashoff bodies,
9:21:13which are nodules within the heart
9:21:14muscle and damaging the heart valves.
9:21:17Risk factors include untreated strep
9:21:19throat, crowded living conditions, poor
9:21:20sanitation, and lower socio-economic
9:21:23status.
9:21:24Common signs and symptoms are new heart
9:21:26murmurss especially affecting the mitro
9:21:28valve, a paricardial friction rub, fever
9:21:30with chills, chest pain, shortness of
9:21:33breath, small red spots or petiki on the
9:21:35trunk and limbs, joint pain and swelling
9:21:38called polyarthritis, involuntary muscle
9:21:41movements known as korea, and painless
9:21:43lumps under the skin known as
9:21:45subcutaneous nodules. As nurses, your
9:21:48key responsibilities include early
9:21:50detection by assessing recent sore
9:21:52throat symptoms and obtaining throat
9:21:53cultures. Monitor patients closely for
9:21:56cardiac complications by listening for
9:21:58new or worsening murmurss. Administer
9:22:00penicellin antibiotics promptly as it's
9:22:02the first line medication to prevent
9:22:04disease progression. Additionally,
9:22:06manage symptoms with non-steroidal
9:22:08anti-inflammatory drugs and educate
9:22:10patients on the importance of
9:22:12prophylactic antibiotics before dental
9:22:14or invasive procedures.
9:22:17Next, let's examine paricarditis. This
9:22:19condition can result from viral or
9:22:21bacterial infections including
9:22:23tuberculosis after a heart attack known
9:22:26as Drestler's syndrome, autoimmune
9:22:28diseases or trauma. It involves
9:22:31inflammation of the paricardial sack
9:22:33surrounding the heart potentially
9:22:34leading to fluid accumulation called
9:22:36paricardial eusion and in severe cases
9:22:40cardiac tampenid. Patients typically
9:22:42experience sharp chest pain that worsens
9:22:44when lying down and improves upon
9:22:46sitting up and leaning forward. Other
9:22:48symptoms include a paricardial friction
9:22:50rub heard best at the left sternal
9:22:52border, shortness of breath, fever with
9:22:54chills, and specific ECG changes like ST
9:22:57segment elevation across multiple leads.
9:23:00In caring for these patients, encourage
9:23:02them to sit upright and lean forward to
9:23:04relieve chest pain. Administer
9:23:06medications like ibuprofen, aspirin, or
9:23:08colisine for inflammation and pain.
9:23:11Vigilantly monitor for signs of cardiac
9:23:13tampenod including low blood pressure,
9:23:15distended jugular veins and muffled
9:23:17heart sounds known as beex triad. Keep
9:23:20an eye on ECG changes and be prepared
9:23:22for paricardioentesis if fluid drainage
9:23:24becomes necessary. Lastly, we'll cover
9:23:26infective endocarditis. It is often
9:23:29caused by bacteria like streptoccus
9:23:31veritins or stafylocus orius and
9:23:33commonly occurs in intravenous drug
9:23:35users, patients who recently had heart
9:23:37surgery or individuals with prosthetic
9:23:39heart valves. The bacteria enter the
9:23:42bloodstream and settle on damaged heart
9:23:43valves forming vegetations that may
9:23:45break off and travel to other organs.
9:23:47Risk factors include introvenous drug
9:23:49use, artificial heart valves, previous
9:23:51endocarditis, congenital heart defects,
9:23:53and poor dental hygiene or recent dental
9:23:55procedures. Symptoms to watch for
9:23:58include fever, flu-l like symptoms such
9:24:00as chills, malaise, weakness, a new or
9:24:03worsening heart murmur, tiny red spots
9:24:06or peticier on the skin, red streaks
9:24:08under the nails called splinter
9:24:09hemorrhages, painless red spots on the
9:24:12palms or soles known as Janeway lesions,
9:24:14painful raised spots on fingers or toes
9:24:16called osler's nodes, and retinal
9:24:18hemorrhages with white centers called
9:24:20Roth spots. Nursing responsibilities for
9:24:23infective endocarditis involve obtaining
9:24:25multiple blood cultures before starting
9:24:27antibiotics to identify the organism
9:24:29accurately. Administer long-term
9:24:31introvenous antibiotics, typically a
9:24:33combination of vanamy and genttoycin for
9:24:364 to 6 weeks. Carefully monitor for
9:24:39complications like stroke, pulmonary
9:24:41embism or kidney damage due to emblei.
9:24:44Regularly assess for signs of heart
9:24:45failure such as new murmurss, worsening
9:24:47breathing difficulty and peripheral
9:24:49swelling. Educate patients on the
9:24:52necessity of prophylactic antibiotics
9:24:53before dental or invasive procedures to
9:24:55prevent recurrence. Regarding laboratory
9:24:58and diagnostic tests for these
9:25:00inflammatory heart conditions, blood
9:25:02cultures help identify the infectious
9:25:04organism. Throat cultures detect group A
9:25:06strepcockus and elevated levels of ESR
9:25:09and CRP indicate inflammation. ECGs
9:25:13reveal important changes like ST segment
9:25:15elevations in paricarditis or conduction
9:25:17problems. Echo cardiograms detect
9:25:20vegetations and valve damage while chest
9:25:22X-rays can show enlarged hearts or fluid
9:25:24buildup around the heart. Fluid buildup
9:25:26around the heart. Now let's summarize
9:25:29the treatment approaches for key
9:25:30cardiovascular conditions clearly and
9:25:32concisely. The first condition is
9:25:34rheumatic endocarditis mainly caused by
9:25:36untreated strep throat infections.
9:25:38Patients often show symptoms such as
9:25:40heart murmurss, fever, joint pain, rash,
9:25:43and involuntary movements known as
9:25:45Korea. Treatment involves administering
9:25:47penicellin to eliminate the bacterial
9:25:49infection along with non-steroidal
9:25:51anti-inflammatory drugs also known as
9:25:53NSADs and corticosteroids to manage
9:25:56inflammation and symptoms. The second
9:25:58condition is paricarditis an
9:26:00inflammation of the heart's paricardial
9:26:02sack. It usually occurs due to viral
9:26:04infections but bacterial infections
9:26:07autoimmune conditions and dresser
9:26:09syndrome following a heart attack
9:26:10myioardial inffection can also cause
9:26:13this condition. Common symptoms include
9:26:15sharp chest pain that improves when
9:26:17sitting upright, a friction rub sound
9:26:19heard upon examination and shortness of
9:26:21breath. The recommended treatments
9:26:23include NSADs, culcasine, steroids for
9:26:26inflammation and paricardioentesis
9:26:28which is the drainage of fluid if
9:26:30cardiac tampenot occurs. The third
9:26:33condition is infective endocarditis
9:26:35often linked to intravenous drug use,
9:26:37prosthetic heart valves and invasive
9:26:40dental procedures. Patients commonly
9:26:42present with heart murmurss, fever,
9:26:43splinter hemorrhages under the nails,
9:26:45tender nodules called osler's nodes, and
9:26:47painless spots known as Janeway lesions.
9:26:50Treatment typically involves introvenous
9:26:52antibiotics administered over four to 6
9:26:54weeks. Severe cases may require surgical
9:26:57valve replacement. Next, let's review
9:26:59the most important enclelex nursing
9:27:00priorities. Always assess patients who
9:27:03present with heart murmurss for any
9:27:04recent sore throat or respiratory
9:27:06infections. Ensure blood cultures are
9:27:09drawn before starting antibiotic therapy
9:27:10in cases suspected of endocarditis.
9:27:13Continuously monitor for serious
9:27:14complications including emolic events,
9:27:17cardiac tampenade and signs of heart
9:27:19failure. Educate high-risisk patients
9:27:22such as those with prosthetic valves or
9:27:23a history of endocarditis about the need
9:27:25for prophylactic antibiotics before
9:27:27undergoing invasive procedures.
9:27:29recognize life-threatening signs quickly
9:27:31such as Beck's triad and cardiac
9:27:33tampenade which includes hypotension,
9:27:36jugular venus distension and muffled
9:27:37heart sounds as well as symptoms of
9:27:39emolic stroke. Moving on, we'll now
9:27:42discuss peripheral vascular diseases
9:27:44abbreviated as PVDs which encompass
9:27:47peripheral arterial disease and
9:27:48peripheral venus disorders. These
9:27:51conditions affect blood circulation
9:27:52especially in the lower extremities
9:27:54potentially leading to eskeeia, ulcers
9:27:56or venus insufficiency. Focusing
9:27:59specifically on peripheral arterial
9:28:01disease. This condition occurs when
9:28:02blood flow to the lower limbs is
9:28:04restricted due to atherosclerosis which
9:28:06is plaque buildup in the arteries. P A
9:28:10can result in reduced blood supply or
9:28:12eskeeia. Risk factors for P A include
9:28:14modifiable factors such as obesity, high
9:28:17cholesterol, hyper lipidmia, diabetes,
9:28:19high blood pressure, hypertension,
9:28:21smoking, and a sedentary lifestyle.
9:28:24Non-modifiable risk factors include
9:28:26advancing age over 50 years and a family
9:28:28history of vascular diseases. Patients
9:28:31with P A commonly experience
9:28:33intermittent claudication described as
9:28:35burning or cramping pain in the legs
9:28:37during exercise which is relieved by
9:28:39placing the legs down. In severe cases,
9:28:42patients may experience pain even while
9:28:44resting, especially at night. Upon
9:28:47physical examination, typical findings
9:28:49include delayed capillary refill taking
9:28:51more than 3 seconds, decreased or absent
9:28:54pulses in the lower limbs, shiny, dry,
9:28:56scaly, or modeled skin, loss of hair on
9:28:59the lower legs and feet, thickened
9:29:01toenails, elevation palar, which means
9:29:03legs appear pale when raised, and
9:29:05dependent ruber, which is redness
9:29:07observed when legs are lowered.
9:29:09Additionally, patients may have eskeemic
9:29:11ulcers on their toes and are at
9:29:13increased risk for gang green. Nursing
9:29:15interventions for managing PAD include
9:29:17encouraging patients to progressively
9:29:19walk until pain develops, resting
9:29:21briefly, and then walking slightly
9:29:23further each time. Patients should be
9:29:25advised to avoid crossing their legs and
9:29:27wearing restrictive clothing.
9:29:28Maintaining warmth by wearing insulated
9:29:30socks can help dilate blood vessels, but
9:29:33direct heat sources should be avoided
9:29:35due to decreased sensation.
9:29:37Additionally, avoiding vasocon factors
9:29:40such as stress, caffeine, and nicotine
9:29:42is important. Legs should be kept in a
9:29:45dependent or lowered position to improve
9:29:47circulation rather than elevated.
9:29:49Finally, nurses should mark pedal pulses
9:29:52clearly to monitor any changes in the
9:29:54patients circulation effectively. Now,
9:29:56let's discuss the medical and surgical
9:29:58management related to peripheral
9:30:00vascular conditions. First, we have
9:30:02medications. Anti-platlet medications
9:30:04like aspirin and clitigil help reduce
9:30:06blood viscosity, meaning they make the
9:30:08blood thinner to prevent clots.
9:30:11Additionally, statins are medications
9:30:12that lower cholesterol levels, helping
9:30:14prevent plaque buildup in the arteries.
9:30:17Next, surgical procedures are available
9:30:19to manage these conditions. One
9:30:21procedure is perccutaneous transuminal
9:30:23angoplasty. During this procedure,
9:30:25doctors insert a balloon or a stent to
9:30:28open narrowed blood vessels. Another
9:30:30common procedure is bypass grafting,
9:30:32which rroots blood flow around blocked
9:30:35arteries. After surgery, specific care
9:30:37is crucial. Nurses must closely monitor
9:30:39for graft occlusion. watching for signs
9:30:41such as diminished pulses, increased
9:30:43pain, or changes in color and
9:30:45temperature in the affected limb.
9:30:47Additionally, patients must keep their
9:30:48extremities straight for about 6 to 8
9:30:50hours following bypass surgery. Nurses
9:30:53should also be alert for compartment
9:30:54syndrome identified by symptoms like
9:30:56severe pain, numbness, swelling, and
9:30:59tightness. Moving on, let's talk about
9:31:02peripheral venus disorders. These
9:31:04conditions impair the vein's ability to
9:31:06return blood to the heart leading to
9:31:07issues like venus stasis, blood clots or
9:31:10venus insufficiency. A significant
9:31:12disorder in this category is venus
9:31:14throbo emolism specifically deep vein
9:31:17thrombosis or DVT. ADVT is a blood clot
9:31:21that forms deep within a vein typically
9:31:24in the legs. If this clot breaks loose
9:31:26and travels to the lungs, it becomes a
9:31:28serious condition called a pulmonary
9:31:30embism.
9:31:31Several risk factors for DVT are
9:31:33summarized by Vershau's triad. These
9:31:35include hypercoagulability, which is an
9:31:37increased tendency to clot, often seen
9:31:39in conditions like cancer, pregnancy, or
9:31:42with oral contraceptive use. Another
9:31:44factor is venous stasis caused by
9:31:46immobility, recent surgery, or heart
9:31:48failure. Lastly, endothelial damage such
9:31:51as injury from surgery, trauma, or
9:31:53central intravenous lines can also
9:31:55trigger clot formation. Signs and
9:31:58symptoms of DVT typically include pain
9:32:00in one calf or groin, sudden swelling of
9:32:02the affected limb, warmth, redness, and
9:32:05hardness over the involved vein.
9:32:08Although home and sign, which is pain on
9:32:09flexing the foot upwards, is mentioned
9:32:11frequently, it is not considered
9:32:13reliable for diagnosis. For patients
9:32:15with DVT, nursing interventions include
9:32:17elevating the affected extremity above
9:32:19heart level. Nurses should avoid placing
9:32:22pillows under the knees to prevent
9:32:24compressing the veins and must never
9:32:26massage the area as this could dislodge
9:32:28the clot. Applying warm moist compresses
9:32:30can help relieve discomfort and
9:32:32compression stockings usually thigh high
9:32:34are recommended once the clot has
9:32:36resolved. Medications for managing DVT
9:32:39include heperin given introvenously or
9:32:42subcutaneously and low molecular weight
9:32:44hepin like anoxiperin. For patients on
9:32:47Hepin, monitoring activated partial
9:32:49thromboplastin time is essential,
9:32:52keeping it within 1.5 to 2.5 times the
9:32:55normal range. Nurses should also monitor
9:32:58for heperin induced thrombocytoenia.
9:33:01Proteamine sulfate serves as the
9:33:02antidote if excessive bleeding occurs.
9:33:05Warerin commonly called couadin is
9:33:07another anti-coagulant used orally. For
9:33:10patients on warerin, it's critical to
9:33:11monitor prothrobin time or PT and the
9:33:15international normalized ratio aiming
9:33:17for a therapeutic international
9:33:18normalized ratio between 2 and three.
9:33:21Warerin takes several days to be
9:33:23effective. So bridging therapy with
9:33:24hepin is usually required. The antidote
9:33:27for warin is vitamin K. In severe cases,
9:33:30thrombolytic medications such as altplay
9:33:33also known as tpa may be used to
9:33:35dissolve existing clots. Patient
9:33:37education regarding anti-coagulant
9:33:39therapy is important. Patients should
9:33:41avoid injuries by using electric razors
9:33:43and soft toothbrushes and maintain
9:33:45consistent vitamin K intake if on
9:33:47warferin. Chronic venus insufficiency is
9:33:50another condition affecting the lower
9:33:51extremities. This occurs when vein
9:33:54valves become incompetent causing venus
9:33:56stasis, ulcers and swelling. Risk
9:33:59factors include prolonged sitting or
9:34:01standing, obesity, and pregnancy.
9:34:03Symptoms often include brown
9:34:04discoloration around the ankles or
9:34:06calves, edema, and venus stasis ulcers,
9:34:09typically shallow with irregular borders
9:34:12found near the ankles. Nursing
9:34:14interventions for chronic venus
9:34:15insufficiency involve leg elevation
9:34:17above the heart, compression therapy
9:34:19applied after reducing edema, and
9:34:21encouraging regular walking to improve
9:34:23circulation.
9:34:25Varicose veins are enlarged, twisted
9:34:27veins caused by faulty valves commonly
9:34:30affecting the legs. Risk factors include
9:34:32advancing age, obesity, pregnancy,
9:34:35prolonged standing, and family history.
9:34:39Symptoms include visibly swollen veins,
9:34:41aching, pain, and heaviness in the legs.
9:34:44Treatment options include scarotherapy,
9:34:46which involves injecting a solution to
9:34:47close off the vein, surgical vein
9:34:49stripping, and the use of compression
9:34:51stockings with leg elevation. Diagnostic
9:34:54tests to evaluate Venus disorders
9:34:55include the D-dimer blood test which if
9:34:58elevated suggests a possible clot and
9:35:01Venus duplex ultrasound used to confirm
9:35:03the presence of DVT. Lastly, key nursing
9:35:06responsibilities for the enclelex
9:35:08include promoting walking and dependent
9:35:10limb positioning for peripheral arterial
9:35:12disease, assessing pulses frequently
9:35:14after surgery, never massaging a leg
9:35:16with suspected DVT, elevating affected
9:35:19limbs, administering anti-coagulants
9:35:21carefully, and monitoring for signs of
9:35:23pulmonary embolism like sudden shortness
9:35:25of breath or chest pain. For CVI and
9:35:28varicose veins, nurses should encourage
9:35:30compression therapy, leg elevation, and
9:35:33carefully assess for the development of
9:35:34ulcers. When managing anti-coagulation
9:35:37therapy, regular monitoring of a PTT for
9:35:40heperin and INR for warfaren along with
9:35:43patient education on bleeding
9:35:44precautions is crucial. Before we move
9:35:46ahead, I want to ask you something. Do
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9:36:49visit our website. The link is in the
9:36:51description. Now let's discuss
9:36:53hypertension. Hypertension is a chronic
9:36:55condition characterized by persistently
9:36:57elevated blood pressure. It
9:36:59significantly increases the risk for
9:37:01serious conditions such as
9:37:02cardiovascular disease, stroke, and
9:37:04kidney failure. Let's first understand
9:37:06how blood pressure is classified. Normal
9:37:09blood pressure is less than 120 over
9:37:11less than 80 mm of mercury.
9:37:14Prehypertension or elevated blood
9:37:16pressure ranges between 120 to 129 over
9:37:19less than 80. Stage 1 hypertension is
9:37:22defined as 130 to 139 over 80 to 89.
9:37:27Stage 2 hypertension involves readings
9:37:29equal to or above 140 over equal to or
9:37:32above 90. Finally, a hypertensive crisis
9:37:35which is a medical emergency occurs with
9:37:38blood pressure greater than 180 over
9:37:41greater than 120. There are two main
9:37:43types of hypertension. First, primary
9:37:45hypertension, also called essential
9:37:47hypertension, has no identifiable cause
9:37:49and accounts for 90 to 95% of cases. Its
9:37:54risk factors include non-modifiable
9:37:56factors like genetics, age, and being of
9:37:58African-American ethnicity. Modifiable
9:38:00risk factors include excess sodium
9:38:02intake, obesity, lack of physical
9:38:04activity, smoking, excessive alcohol
9:38:07use, high cholesterol, and stress.
9:38:10Second, secondary hypertension occurs
9:38:12due to an underlying medical condition.
9:38:14Common causes include renal disorders
9:38:16such as chronic kidney disease or
9:38:18narrowing of the renal artery, endocrine
9:38:20disorders like Cushings disease,
9:38:22focytoma
9:38:24and hyperldrinism,
9:38:26cardiovascular disorders such as
9:38:28cortation of the aorta and neurological
9:38:30disorders that cause increased
9:38:31intraanial pressure. If hypertension is
9:38:34not controlled, serious complications
9:38:36can arise known as target organ damage.
9:38:39This damage can affect the heart causing
9:38:41issues such as left ventricular
9:38:42hypertrophy, heart failure or heart
9:38:44attack. It can affect the brain leading
9:38:47to stroke or transient eskeemic attacks.
9:38:49It can damage the eyes resulting in
9:38:51hypertensive retinopathy and vision loss
9:38:53and it can harm the kidneys potentially
9:38:55leading to chronic kidney disease or
9:38:57renal failure. Hypertension is often
9:38:59called a silent killer because it
9:39:01frequently shows no symptoms. However,
9:39:03severe cases may cause noticeable
9:39:04symptoms like headaches, especially in
9:39:07the morning. Dizziness, blurred vision,
9:39:09or nose bleeds. Now, let's talk about
9:39:12pharmacological management. Various
9:39:14medications lower blood pressure through
9:39:16different mechanisms. First, diuretics
9:39:18reduce blood volume by increasing urine
9:39:20output. Examples include thioide
9:39:22diuretics like hydrochloroioide,
9:39:25which require monitoring for low
9:39:26potassium. Loop diuretics such as
9:39:29ferosomide also carry risks of low
9:39:31potassium and hearing damage known as
9:39:33autotoxicity. Potassium sparing
9:39:35diuretics like spironolactone may lead
9:39:38to high potassium levels. Calcium
9:39:40channel blockers or CCBs relax blood
9:39:42vessels. Common examples are vermloopine
9:39:46and deltism. Nurses should advise
9:39:49patients to avoid grapefruit juice to
9:39:50prevent drug toxicity and monitor for
9:39:52slow heart rate, low blood pressure and
9:39:54swelling in extremities. ACE inhibitors
9:39:57medications ending in prill block the
9:39:59enzyme that causes blood vessels to
9:40:01constrict. Examples are leinopril and
9:40:04analopril. Side effects can include
9:40:06angioadeema, dry cough and elevated
9:40:08potassium levels. Angotensin 2 receptor
9:40:11blockers or ARBs ending in sartin block
9:40:14angotensin 2 thereby reducing blood
9:40:17pressure. Examples include loartin and
9:40:20valartin with potential side effects
9:40:22like angioadeema, hyp potassium and
9:40:24worsening heart failure. Beta blockers
9:40:27ending in LOL both heart rate and blood
9:40:30pressure. Examples are metiprolol and
9:40:33propranrenol. Patients may experience
9:40:35fatigue, weakness, sexual dysfunction
9:40:37and they can mask signs of low blood
9:40:39sugar in diabetic patients.
9:40:41Aldoststerone receptor antagonists block
9:40:43eldoststerone and may cause increased
9:40:46potassium, low sodium and elevated
9:40:48triglycerides. Central alpha agonists
9:40:51such as clonodine lower blood pressure
9:40:53through the central nervous system
9:40:55possibly causing sedation, dry mouth and
9:40:57dizziness upon standing known as
9:41:00orthostatic hypotension. In a
9:41:02hypertensive crisis, symptoms like
9:41:04severe headache, blurred vision and
9:41:06dizziness occur. Treatment involves
9:41:08introvenous anti-hypertensive
9:41:10medications such as nitropide, leettool
9:41:13or nicardipine. For nursing
9:41:15responsibilities important for enclelex,
9:41:17nurses must correctly measure blood
9:41:19pressure using the proper cuff size and
9:41:21technique. Measuring initially in both
9:41:23arms and using the higher reading. Blood
9:41:25pressure should be checked while seated
9:41:27with feet flat and arm at heart level.
9:41:29Assessing for orthostatic hypotension is
9:41:31crucial. Patients should be instructed
9:41:33to change positions slowly to avoid
9:41:35falls. Lifestyle modifications are
9:41:37first-line interventions before
9:41:39medications. These include the DASH
9:41:41diet, low in sodium and rich in
9:41:43potassium, calcium, and magnesium.
9:41:45Limiting alcohol consumption, quitting
9:41:47smoking, managing stress, and losing
9:41:49weight. Patient education on medications
9:41:51is critical. Patients should take
9:41:53medications consistently, never stop
9:41:54them abruptly to avoid rebound
9:41:56hypertension, and recognize important
9:41:58side effects. Recognizing hypertensive
9:42:01crisis is crucial on the ENCLEX.
9:42:03Immediate action is required if blood
9:42:05pressure exceeds 180 over 120,
9:42:08especially if accompanied by symptoms
9:42:09like confusion, chest pain, shortness of
9:42:12breath, or seizures. Nurses should
9:42:14administer introvenous antihypertensives
9:42:16as prescribed and monitor blood pressure
9:42:18every 5 to 15 minutes until stabilized.
9:42:21Monitoring renal function is also
9:42:23important. Nurses should regularly
9:42:25assess blood ura nitrogen, creatinine,
9:42:27and glomemeular filtration rate and
9:42:29watch for signs of fluid overload like
9:42:31edema or rapid weight gain. Finally,
9:42:34here is a sample enclelex practice
9:42:35question. A patient with newly diagnosed
9:42:37hypertension is prescribed listenril.
9:42:40Which statement by the patient requires
9:42:42further teaching? Option A, I will check
9:42:45my blood pressure regularly at home.
9:42:47Option B, I need to notify my provider
9:42:50if I develop a persistent cough. Option
9:42:53C, I can stop taking this medication
9:42:55once my blood pressure is normal. Option
9:42:57D, I should avoid using salt substitutes
9:42:59that contain potassium. The correct
9:43:02answer is option C because hypertension
9:43:04requires lifelong medication and
9:43:06stopping suddenly can cause rebound
9:43:08hypertension. Now, we will discuss
9:43:10hemodynamic shock, a life-threatening
9:43:12condition where tissues do not receive
9:43:14enough blood supply. If left untreated,
9:43:17this condition can quickly lead to
9:43:19multiple organ failure and death.
9:43:21Hemodnamic shock is classified into four
9:43:23main types. Cardiogenic shock, hypoalmic
9:43:26shock, obstructive shock, and
9:43:28distributive shock, which includes
9:43:30septic, neurogenic, and anaphylactic
9:43:32shock. Each type has its own distinct
9:43:34causes, symptoms, and management
9:43:36strategies. Let's start with cardiogenic
9:43:38shock. This type of shock occurs when
9:43:40the heart cannot pump effectively due to
9:43:42reasons such as a heart attack known as
9:43:44myioardial inffection, heart failure, or
9:43:47abnormal heart rhythms, dysriythmias.
9:43:50Some key findings include elevated
9:43:52cardiac enzymes such as tropponin and
9:43:54CKMBB, low blood pressure, hypotension,
9:43:57rapid heart rate, tacocardia, weak
9:44:00pulses, lung congestion with crackles,
9:44:02distended neck veins known as jugular
9:44:04vein distension, JVD, and decreased
9:44:07hemoglobin and hematocrit levels. The
9:44:10treatment involves giving medications
9:44:11like vasopressors such as dobbutamine
9:44:14and norepinephrine and nitropide which
9:44:17helps reduce pressure in the vessels
9:44:18around the heart. Oxygen therapy or
9:44:21mechanical ventilation might also be
9:44:22needed and continuous monitoring of ECG
9:44:25for abnormal heart rhythms is crucial
9:44:27for nursing priorities related to
9:44:29enclelex. Nurses must continuously
9:44:31monitor cardiac enzymes and ECG.
9:44:34Carefully administer fluids to avoid
9:44:36overloading the patient and closely
9:44:38watch urine output which should always
9:44:40be greater than 30 ml per hour to ensure
9:44:43good tissue profusion. Next we have
9:44:45hypoalmic shock. This type occurs due to
9:44:47excessive fluid loss from the body which
9:44:50might happen due to bleeding,
9:44:51hemorrhage, severe vomiting, diarrhea,
9:44:54burns, trauma or surgery. Important
9:44:57signs include low blood pressure,
9:44:59hypotension, rapid heart rate,
9:45:01tacocardia, weak pulses, decreased skin
9:45:04toree, dry mucous membranes, and reduced
9:45:07hemoglobin and hematocrit levels.
9:45:09Treatment involves quickly restoring
9:45:11fluids using isotonic crystalloid
9:45:13solutions like normal saline or lactated
9:45:15ringers and blood products if the
9:45:17patient is bleeding heavily. Medications
9:45:20such as dopamine or norepinephrine may
9:45:22also be used to support blood pressure.
9:45:24Enclelex nursing priorities include
9:45:27closely monitoring urine output and
9:45:29reporting immediately if it falls below
9:45:3130 milliliters per hour, placing the
9:45:33patient flat with legs elevated known as
9:45:35the trendelinberg position to improve
9:45:37blood return to the heart and
9:45:39continuously checking for signs of fluid
9:45:41overload like crackles in the lungs,
9:45:43difficulty breathing and swelling edma.
9:45:46Thirdly, we have obstructive shock. This
9:45:49happens when blood flow is physically
9:45:50blocked commonly due to conditions such
9:45:52as pulmonary embolism, tension,
9:45:54pneumathorax or cardiac tampenod. Key
9:45:57symptoms include sudden low blood
9:45:58pressure, hypotension, rapid heartbeat,
9:46:01tacocardia, distended neck veins and
9:46:03reduced or absent breath sounds if there
9:46:05is a pneumathorax. Treatment focuses on
9:46:08correcting the underlying issue. For
9:46:09example, inserting a chest tube for a
9:46:11collapsed lung pumothorax, performing
9:46:14paricardioentesis to relieve cardiac
9:46:16tampenade or giving thrombolytic
9:46:18medications for a pulmonary embism.
9:46:20Enclelex nursing priorities include
9:46:22preparing immediately for emergency
9:46:24interventions such as needle
9:46:25decompression, paricardioentesis or
9:46:28surgery, administering oxygen and
9:46:31monitoring for worsening respiratory
9:46:33distress. Finally we discuss
9:46:35distributive shock which occurs due to
9:46:38widespread vasoddilation and increased
9:46:40capillary permeability. It includes
9:46:42three subtypes septic neurogenic and
9:46:45anaphylactic shock. First septic shock.
9:46:49This occurs due to severe infections
9:46:51typically caused by gram negative
9:46:52bacteria or conditions like eurospepsis
9:46:55especially common in the elderly.
9:46:58Symptoms initially include low blood
9:46:59pressure, hypotension, rapid heart rate,
9:47:01tacocardia, and fever with skin
9:47:04appearing warm and flushed initially but
9:47:06becoming cool and modeled in later
9:47:07stages. Lab findings typically show
9:47:10elevated lactic acid levels and positive
9:47:12blood cultures. Treatment involves
9:47:14administering large amounts of isotonic
9:47:16fluids, antibiotics such as vanamycin
9:47:18and pyproin tazobactam and vasopressors
9:47:21if fluids alone are ineffective.
9:47:24Enclelex nursing priorities include
9:47:25drawing blood cultures before starting
9:47:27antibiotics and continuously monitoring
9:47:29for signs of organ dysfunction such as
9:47:31decreased urine output, algoria,
9:47:33confusion, and increased lactic acid
9:47:35levels. Next is neurogenic shock caused
9:47:38by spinal cord injury such as trauma
9:47:40leading to paraplegia or quadriplegia.
9:47:43Unique symptoms here include low blood
9:47:44pressure, hypotension combined with a
9:47:46slow heart rate, radiardia, and the
9:47:49patients skin typically appears warm and
9:47:51dry. Treatment involves first giving
9:47:54fluids followed by vasopressors such as
9:47:56norepinephrine or dopamine and atropene
9:47:59to treat slow heart rate. Nursing
9:48:02priorities include closely monitoring
9:48:03for loss of the body's ability to
9:48:05regulate temperature and raising the
9:48:07head of the bed slowly to prevent sudden
9:48:09drops in blood pressure orthostatic
9:48:11hypotension. Then we have anaphylactic
9:48:13shock which is a severe allergic
9:48:15reaction. Key signs are low blood
9:48:17pressure, hypotension, wheezing,
9:48:19swelling known as angioadema, hives, and
9:48:21significant breathing difficulties.
9:48:23Immediate treatment includes giving
9:48:25intramuscular epinephrine,
9:48:27antihistamines like diffhydramine,
9:48:29corticosteroids, intravenous fluids, and
9:48:32oxygen therapy. Nursing priorities
9:48:34include maintaining a clear airway,
9:48:36preparing for potential intubation if
9:48:38necessary, and educating the patient
9:48:40about using an EpiPen for future
9:48:42allergic reactions. Lastly, a major
9:48:45complication of any type of shock is
9:48:47multiple organ dysfunction syndrome
9:48:49abbreviated as M OS. In mods, organs
9:48:52progressively fail, including kidneys,
9:48:54lungs, liver, and the heart. Important
9:48:56signs include rapid heartbeat,
9:48:58teacardia, fast breathing, tacipnia, and
9:49:01worsening organ function. Management
9:49:03primarily includes supportive care
9:49:05measures such as mechanical ventilation,
9:49:07diialysis, and careful monitoring for
9:49:09signs of further deterioration.
9:49:12Now let's discuss disseminated
9:49:14intravascular coagulation in IC.
9:49:16Widespread clot formation happens first
9:49:19and this is quickly followed by
9:49:20excessive bleeding. Patients may show
9:49:22signs such as bruising, small pinpoint
9:49:24red spots called petiki, blood in the
9:49:27urine known as hematuria and
9:49:29gastrointestinal bleeding. Treatment for
9:49:31DIC includes giving blood transfusions,
9:49:33platelets, and clotting factors like
9:49:35fresh frozen plasma. Nurses must closely
9:49:38monitor lab values such as prothroen
9:49:40time, partial thromboplastin time and
9:49:43international normalized ratio for the
9:49:45exam. Nursing priorities include closely
9:49:47monitoring for any signs of bleeding
9:49:49from the gums, urine, stool or
9:49:51intravenous sites. Additionally, nurses
9:49:53should avoid intramuscular injections
9:49:55and unnecessary venopunctures to prevent
9:49:57additional bleeding. Next, we will talk
9:49:59about aneurysms. An aneurysm is an
9:50:02abnormal widening or ballooning of a
9:50:04blood vessel due to weakness in the
9:50:05vessel wall. Risk factors for aneurysms
9:50:08include being male, smoking, high blood
9:50:10pressure, hypertension, atherosclerosis,
9:50:13and aging. The first type we'll cover is
9:50:15an abdominal aortic aneurysm. Key signs
9:50:18include flank or back pain, and a
9:50:20pulsating abdominal mass. It's important
9:50:22not to palpate this mass because it can
9:50:24cause the aneurysm to rupture. Treatment
9:50:27involves surgery if the aneurysm is
9:50:29greater than 6 cm or symptomatic. Nurses
9:50:31need to closely monitor the patient's
9:50:33blood pressure, aiming for a range of
9:50:35100 to 120 mm of mercury and always be
9:50:38prepared for emergency surgery in case
9:50:41of rupture. Next is a thoracic aortic
9:50:44aneurysm found in the chest area.
9:50:46Patients often experience severe back
9:50:48pain, coughing, shortness of breath, and
9:50:50difficulty swallowing. Diagnosis is
9:50:53typically made using X-rays or a CT
9:50:56scan. Another critical condition is an
9:50:58aortic dissection. Here patients will
9:51:00have sudden severe tearing or ripping
9:51:03pain in the chest or back. They may
9:51:05quickly enter hypoalmic shock showing
9:51:08signs such as low blood pressure,
9:51:09hypotension, rapid heart rate,
9:51:12tacocardia, and absent pulses. Treatment
9:51:15requires immediate emergency surgery.
9:51:17Nursing priorities include keeping blood
9:51:19pressure controlled using beta blockers
9:51:20or anti-hypertensive medications and
9:51:23closely monitoring for signs of rupture
9:51:25such as sudden severe pain and
9:51:26hypotension. Now let's move on to blood
9:51:29and blood product transfusions. A
9:51:31crucial area in patient care and
9:51:32commonly tested on the enclelex exam.
9:51:35We'll start with a logus transfusions.
9:51:38This process involves patients donating
9:51:39their own blood ahead of time, usually
9:51:41between 6 weeks and 72 hours before
9:51:43surgery. Doing this helps ensure blood
9:51:46availability and prevents complications.
9:51:49Understanding blood types and their
9:51:50compatibility is essential to prevent
9:51:52life-threatening transfusion reactions.
9:51:54Let's simplify this. Type A blood has A
9:51:58antigens and B antibodies, and these
9:52:00patients can safely receive blood types
9:52:02A and O. Type B blood has B antigens and
9:52:05A antibodies, making it safe to receive
9:52:07blood types B and O. Type A blood has
9:52:11both A and B antigens but no antibodies
9:52:13which allows these patients to receive
9:52:15blood from types A, B, A, B and O. This
9:52:19type is called the universal recipient.
9:52:21Type O blood has no antigens but has A
9:52:24and B antibodies. Therefore, patients
9:52:26with type O can only receive type O
9:52:28blood but type O is known as the
9:52:31universal donor type. Another critical
9:52:33factor is the Rh factor. Rh positive
9:52:36blood can only be given to Rh positive
9:52:38patients. Rh- negative patients must
9:52:41never receive Rh- positive blood to
9:52:43avoid severe hemolytic reactions.
9:52:45Finally, let's mention rogam. Rogam is
9:52:48administered to rich negative mothers at
9:52:5028 weeks of pregnancy and again within
9:52:5272 hours after delivery if the newborn
9:52:54is Rh positive. This helps prevent
9:52:57hemolytic disease of the newborn. Let's
9:52:59now understand the blood transfusion
9:53:00procedure along with the key nursing
9:53:02responsibilities involved. First, there
9:53:04are important pre-transfusion steps to
9:53:06follow carefully. Obtain informed
9:53:09consent from the patient before
9:53:10beginning the procedure. Establish
9:53:12introvenous access using a large bore
9:53:14needle, typically an 18 to 20 gauge
9:53:17needle. Two licensed registered nurses
9:53:20must together verify the patients
9:53:21identity, the compatibility of the blood
9:53:23product, and its expiration date. Before
9:53:26starting, prime the blood administration
9:53:29tubing with 0.9% sodium chloride
9:53:32solution, which is also known as normal
9:53:34saline. Never use other fluids like
9:53:36lactated ringers or any dextrose
9:53:38containing solutions for this step.
9:53:40Next, let's see what happens during the
9:53:42transfusion itself.
9:53:45Start the transfusion slowly, usually at
9:53:47a rate of 2 milll per minute for the
9:53:49first 15 minutes. Stay with the patient
9:53:51for at least 15 to 30 minutes to closely
9:53:54monitor them for any transfusion
9:53:56reactions. Carefully check and document
9:53:58the patients vital signs immediately
9:54:00before starting the transfusion, again
9:54:0215 minutes after initiating it, and
9:54:05finally at the completion of the
9:54:06transfusion. Now, let's talk about
9:54:09potential transfusion reactions and how
9:54:10to manage each type. First, there is the
9:54:13acute hemolytic reaction, which is
9:54:15life-threatening. Symptoms include
9:54:16chills, fever, low back pain, rapid
9:54:18heart rate, also called tacocardia,
9:54:21flushing of the skin, low blood pressure
9:54:23known as hypotension, and blood in the
9:54:26urine hemuria.
9:54:28The nursing action here is to stop the
9:54:29transfusion immediately, administer
9:54:32normal saline through a separate
9:54:33intravenous line, notify the health care
9:54:36provider immediately, and closely
9:54:38monitor the patient for signs of shock.
9:54:40Second is the febrile non-hemolytic
9:54:43reaction, which is less severe.
9:54:46Symptoms include fever greater than a
9:54:481°ree C increase, chills, headache,
9:54:50muscle stiffness, and nervousness. The
9:54:53nursing action in this case is to stop
9:54:55the transfusion and administer an
9:54:56antiparetic medication such as
9:54:58acetaminophen to lower the fever. Third,
9:55:02a mild allergic reaction can occur.
9:55:05Symptoms are itching, hives, also known
9:55:07as urticaria, and skin flushing. The
9:55:10nurse should stop the transfusion and
9:55:12administer an antihistamine medication
9:55:14such as dyen hydramine commonly known as
9:55:17benadryil. Fourth is the anaphylactic
9:55:20reaction. A serious and immediate
9:55:22allergic response. Symptoms include
9:55:25bronco spasm, swelling in the throat
9:55:27known as lingial edema, severe drop in
9:55:29blood pressure, hypotension, and signs
9:55:32of shock. Immediately stop the
9:55:34transfusion. Administer epinephrine also
9:55:36known as adrenaline. give oxygen
9:55:38therapy, intravenous fluids, and
9:55:40vasopressor medications to stabilize
9:55:42blood pressure. Lastly, circulatory
9:55:44overload can happen especially in
9:55:46patients with congestive heart failure.
9:55:48Symptoms include difficulty breathing
9:55:50known as dispia, rapid heartbeat,
9:55:52tacocardia, high blood pressure,
9:55:54hypertension, visible neck veins,
9:55:56jugular vein distension, crackling
9:55:58sounds in the lungs, and swelling in the
9:56:00extremities, peripheral edma.
9:56:03Nursing actions include slowing down the
9:56:05transfusion rate, placing the patient in
9:56:07a high fowler's position to help
9:56:08breathing, and administering diuretic
9:56:10medications if ordered by the healthcare
9:56:12provider. Before we dive into next
9:56:15topic, here's something important. You
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9:57:00description below. Now, let's discuss
9:57:02anemia, which is a condition
9:57:03characterized by inadequate red blood
9:57:05cells or hemoglobin or both. Because of
9:57:08this, tissues and organs do not receive
9:57:10enough oxygen. Anemia can occur due to
9:57:12blood loss, decreased production of red
9:57:14blood cells, increased destruction of
9:57:16these cells, or nutritional
9:57:18deficiencies. Let's first talk about the
9:57:20causes of anemia. Number one, blood
9:57:22loss. This can happen from trauma,
9:57:24surgery, gastrointestinal bleeding such
9:57:26as ulcers or colarctal cancer or heavy
9:57:29menstrual bleeding, also known as
9:57:30menorasia. Number two, decreased
9:57:33production of red blood cells. This can
9:57:36result from bone marrow suppression
9:57:38caused by chemotherapy, radiation,
9:57:40leukemia, or a condition called a
9:57:42plastic anemia. Nutritional deficiencies
9:57:45of iron, vitamin B12, or folic acid can
9:57:48also reduce red blood cell production.
9:57:50Number three, increased destruction of
9:57:53red blood cells known as hemolleysis.
9:57:55This occurs in conditions such as cickle
9:57:57cell disease where abnormal cells block
9:58:00blood vessels, autoimmune hemolytic
9:58:01anemia, certain infections or reactions
9:58:04to some medications. Number four,
9:58:06nutritional deficiencies specifically
9:58:08affecting blood cells. Iron deficiency
9:58:11anemia is most common in children due to
9:58:13excessive milk intake and in pregnant
9:58:16women. Vitamin B12 deficiency might be
9:58:18due to poor intake or the lack of
9:58:20intrinsic factor causing pernicious
9:58:22anemia. Folic acid deficiency is
9:58:24critical especially during pregnancy
9:58:26because it can lead to birth defects
9:58:27involving the brain and spine. Number
9:58:30five, chronic conditions. Diseases like
9:58:32chronic kidney disease decrease
9:58:33ariththropoadin production reducing red
9:58:36blood cell production. Chronic
9:58:38inflammatory diseases such as rheumatoid
9:58:40arthritis or HIV infection can also
9:58:42cause anemia. Next, let's look at signs
9:58:45and symptoms you might see in anemia.
9:58:48Generally, people experience fatigue,
9:58:50pale skin known as palar, weakness,
9:58:52dizziness, and sometimes fainting.
9:58:54Cardiovascular symptoms include
9:58:56increased heart rate known as tacoc
9:58:58cardia, palpitations, and low blood
9:59:00pressure in severe cases. Respiratory
9:59:03symptoms often involve shortness of
9:59:04breath during activity. Neurologically,
9:59:07patients might feel numbness or
9:59:09tingling, especially in vitamin B12
9:59:11deficiency, or have headaches. Skin and
9:59:14nail signs include brittle nails,
9:59:16spoon-shaped nails called kolonicia,
9:59:19inflammation of the tongue called
9:59:20glossitis, and cracks at the corners of
9:59:22the mouth known as chilitis. Now nursing
9:59:26care and key responsibilities you should
9:59:28know for exams like the and clelex
9:59:30include for iron deficiency anemia
9:59:32administer oral iron usually ferrris
9:59:35sulfate with vitamin C to increase
9:59:37absorption. Avoid giving iron with dairy
9:59:39products, caffeine or antacids within 1
9:59:42hour because these reduce absorption.
9:59:45Educate patients about black colored
9:59:47stools, a normal side effect of iron
9:59:49supplements. In severe cases,
9:59:51introvenous iron dextrand can be given
9:59:53using the Ztrack method to avoid skin
9:59:55staining. In cases of vitamin B12
9:59:58deficiency or pernicious anemia, first
10:00:01identify if intrinsic factor is missing.
10:00:03If absent, lifelong monthly B12
10:00:05injections called cyanocobalamin are
10:00:08necessary. If dietary patients should
10:00:10consume foods high in B12 such as meat,
10:00:12eggs, and dairy products for folic acid
10:00:15deficiency, supplementing with folic
10:00:17acid is crucial, especially during
10:00:19pregnancy. An important enclelex fact is
10:00:21that high doses of folic acid can hide
10:00:24symptoms of a B12 deficiency leading to
10:00:26neurological problems. In anemia
10:00:29associated with chronic kidney disease
10:00:30or cancer, arythropoesis stimulating
10:00:33agents such as epoitin alpha are given.
10:00:36It's vital to monitor hemoglobin and
10:00:38hematocrit levels twice weekly to avoid
10:00:40polyythemia, a condition of excessive
10:00:42red blood cells increasing clotting
10:00:44risks. Stop a poetin alpha if hemoglobin
10:00:48rises above 11 grams per desiliter to
10:00:50prevent clotting complications.
10:00:52Blood transfusions are reserved for
10:00:54severe anemia cases. Monitor closely for
10:00:56transfusion reactions like fever,
10:00:58chills, rash, back pain, rapid heart
10:01:01rate or low blood pressure. Always flush
10:01:04introvenous lines using normal saline to
10:01:06prevent red blood cell breakdown.
10:01:08Administer transfusions slowly,
10:01:10frequently checking vital signs. If
10:01:12anemia goes untreated, it can lead to
10:01:15serious complications like heart failure
10:01:17due to increased strain on the heart
10:01:19from chronic oxygen shortage,
10:01:20developmental delays in children, or
10:01:23pregnancy complications such as neural
10:01:24tube defects or premature birth. Next,
10:01:27let's discuss essential gastrointestinal
10:01:29diagnostic procedures which help
10:01:31identify problems in the liver,
10:01:33pancreas, intestines, and other
10:01:35digestive organs.
10:01:37Liver function tests measure enzymes
10:01:39such as ALT and AST normally below 40
10:01:43units per liter. Berubin levels should
10:01:45remain below 1 milligram per deciliter.
10:01:48High levels indicate liver problems or
10:01:50bile obstruction. Albumin normally
10:01:52between 3.5 to 5 g per deciliter
10:01:55indicates nutrition status or liver
10:01:57disease if low. Ammonia should be below
10:02:00100 micrograms per deciliter. Higher
10:02:02levels occur in liver failure causing
10:02:04hpatic and sephylopathy. Pancreatic
10:02:07function tests include amalayase and
10:02:09lipase both typically below 100 units
10:02:12per liter. Elevated levels indicate
10:02:14pancreatitis with lipase being more
10:02:16specific. A fecal occult blood test
10:02:19checks stool samples for hidden blood
10:02:21which can signal ulcers, colitis or
10:02:23colctal cancer. Endoscopy procedures are
10:02:26valuable diagnostic tools. Colonoscopy
10:02:28examines the colon via the anus under
10:02:30sedation with the patient positioned on
10:02:32their left side with knees drawn toward
10:02:34the chest. Preparation involves bowel
10:02:36cleansing, a clear liquid diet, avoiding
10:02:38red, purple, or orange fluids and no
10:02:40food or drink after midnight. An
10:02:42esophagastuodonoscopy
10:02:44examines the esophagus, stomach, and
10:02:46douadinum through the mouth requiring no
10:02:49food or drink for 6 to 8 hours prior.
10:02:51Sigmoidoscopy examines the sigmoid colon
10:02:53without sedation positioned similarly to
10:02:56colonoscopy with bowel preparation and a
10:02:58clear liquid diet 24 hours before and
10:03:01fasting after midnight. Complications
10:03:03from endoscopy include bleeding
10:03:05indicated by rapid heart rate, rapid
10:03:07breathing or low blood pressure and
10:03:09aspiration risks like difficulty
10:03:11breathing or fever. Finally, a
10:03:13gastrointestinal series uses contrast
10:03:16agents like barerium swallowed or given
10:03:18by enema. Before the test, patients
10:03:20follow a clear liquid or low residue
10:03:22diet, fasting after midnight, and avoid
10:03:25smoking or gum chewing, which increases
10:03:26digestive activity. Afterward, patients
10:03:29should drink fluids to clear the
10:03:30contrast, expecting white stools for 1
10:03:33to 3 days until the barerium fully
10:03:35clears from the system. Now, we will
10:03:37discuss important therapeutic procedures
10:03:39used to treat gastrointestinal disorders
10:03:41and their nursing responsibilities. The
10:03:43first procedure is ental feedings which
10:03:46are indicated for patients who are
10:03:47comeomaosse, intubated or have
10:03:49difficulty swallowing known as
10:03:50dysphasia. Nursing responsibilities for
10:03:53ental feedings include checking the
10:03:55residual volume every 4 to 6 hours. If
10:03:58the residual volume is greater than 100
10:04:00to 200 ml, feedings should be
10:04:03temporarily held to prevent
10:04:04complications. Next, we have total
10:04:06parental nutrition, also known as TPN,
10:04:09which is administered through a central
10:04:11introvenous line. It is given to
10:04:13patients experiencing malnutrition or
10:04:15hyper metabolic states. Nurses must
10:04:17perform daily laboratory monitoring,
10:04:19change the tubing and solution every 24
10:04:21hours and use filtered tubing to remove
10:04:23any particles. Blood glucose levels must
10:04:25be checked every 4 to 6 hours for the
10:04:28first 24 hours. Always keep a solution
10:04:30of dextrose 10% in water at the bedside
10:04:32to prevent low blood sugar if the TPN is
10:04:35disrupted. Complications of TPN include
10:04:38air embolism and infection. If an air
10:04:41embolism occurs, immediately clamp the
10:04:43catheter, position the patient on the
10:04:45left side in trendelenburgg, head down,
10:04:47feet up, administer oxygen, and notify
10:04:50the healthcare provider. For infections,
10:04:52monitor the central line site carefully
10:04:53for redness, tenderness or discharge,
10:04:56and avoid using the TPN line for other
10:04:58intravenous fluids or medications.
10:05:00Another procedure is paracentesis, which
10:05:03involves inserting a needle into the
10:05:05paranal cavity to relieve pressure from
10:05:07excess fluid known as acites. Before
10:05:10this procedure, verify informed consent.
10:05:13Have the patient empty their bladder to
10:05:15prevent injury. Position them upright
10:05:17and record vital signs, weight, and
10:05:19abdominal girth. After the procedure,
10:05:22continue monitoring vital signs, weight,
10:05:24and abdominal girth, and administer
10:05:26introvenous fluids or albumin as ordered
10:05:28to prevent low blood pressure. Beriatric
10:05:30surgery such as gastric bypass requires
10:05:33careful post-operative nursing care.
10:05:36Initially, fluids should be resumed
10:05:37slowly, starting with about 30
10:05:39milliliters per intake, gradually
10:05:41increasing as tolerated. Patients should
10:05:43eat six small meals daily. Nurses must
10:05:46watch for dumping syndrome, a
10:05:47complication characterized by cramps,
10:05:49diarrhea, rapid heartbeat, dizziness,
10:05:51and fatigue. Nasogastric decompression
10:05:54is used in cases of intestinal
10:05:55obstruction to relieve abdominal
10:05:57pressure. Indications for this include
10:05:59vomiting, absence of bowel sounds, also
10:06:02called paralytic alas, high-pitched
10:06:05bowel sounds indicating obstruction,
10:06:07abdominal pain, and distension. Nursing
10:06:09responsibilities include regularly
10:06:11assessing bowel sounds, measuring
10:06:13abdominal girth after placement, and
10:06:16monitoring for signs of tube
10:06:17displacement such as decreased drainage,
10:06:20increased nausea, vomiting, or abdominal
10:06:22distension. Osttomies are surgical
10:06:24openings created to bypass certain
10:06:26gastrointestinal regions. An ilostomy
10:06:29involves the idilium and produces
10:06:31frequent liquid stools whereas a
10:06:32colostomy involves the large intestine
10:06:35and produces more formed stools. Nurses
10:06:38must ensure that the sto appears pink
10:06:39and moist and empty. The osttomy bag
10:06:42when it is 1/4 to 1/2 full. Potential
10:06:46complications include eskeeia indicated
10:06:48by a pale pink or bluish purple dry sto
10:06:51requiring immediate medical attention.
10:06:53Patients with osttomies are also at risk
10:06:55for dehydration. So adequate fluid
10:06:57intake should be encouraged. Now let's
10:07:00highlight enclelex focused nursing
10:07:02priorities. Before any gastrointestinal
10:07:04procedure, ensure the patient maintains
10:07:06nothing by mouth status. Assess for
10:07:08allergies, especially to contrast dye or
10:07:10anesthesia and confirm informed consent.
10:07:13After invasive procedures, closely
10:07:15monitor for signs of bleeding,
10:07:17perforation indicated by a rigid
10:07:18abdomen, severe pain or fever,
10:07:21aspiration, and infection. For ental
10:07:24feedings, always check residual volumes.
10:07:26Maintain the head of the bed at 30° or
10:07:28higher, and take steps to prevent
10:07:30aspiration pneumonia. For TPN, monitor
10:07:32glucose levels closely, change tubing
10:07:34every 24 hours, and follow strict
10:07:37sterile technique. For paracentesis,
10:07:39watch closely for low blood pressure and
10:07:41fluid shifts regularly. Check vital
10:07:42signs and monitor albumin levels for
10:07:45patients with osttomies. Educate them on
10:07:47proper stomach care, protecting
10:07:49surrounding skin and recognizing
10:07:50complications. Finally, we will discuss
10:07:53esophageal disorders, specifically
10:07:55gastroosophageal reflux disease known as
10:07:57gird and esophageal varies, both
10:08:00important topics on the enclelex exam.
10:08:03Gird occurs when stomach contents
10:08:05including acid and digestive enzymes
10:08:06flow back into the esophagus causing
10:08:08irritation and inflammation. Risk
10:08:11factors include dietary triggers like
10:08:13fatty or fried foods, chocolate,
10:08:15caffeine, peppermint, spicy foods,
10:08:17tomatoes, citrus fruits, and alcohol.
10:08:20Physiological factors include obesity,
10:08:22pregnancy, and increased abdominal
10:08:24pressure such as from acites or bending
10:08:26at the waist. Lifestyle factors like
10:08:28smoking, delayed stomach emptying, and
10:08:30hyal hernia also contribute. Clinical
10:08:33symptoms of gird include heartburn,
10:08:35worsening when lying down or bending
10:08:37over, regurgitation with a sour or
10:08:39bitter taste, chronic cough,
10:08:42horarsseness, sore throat, difficulty
10:08:44swallowing, and chest pain similar to
10:08:46angina that improves when sitting up,
10:08:48drinking water, or taking antacids.
10:08:50Diagnostics include
10:08:51esophagastroduodonoscopy
10:08:53to identify Barrett's esophagus, a
10:08:55premolignant condition, and pH
10:08:57monitoring to confirm acid reflux.
10:08:59Medications include proton pump
10:09:01inhibitors such as pantoprazole or
10:09:04omipresole. Antacids like aluminum
10:09:06hydroxide or magnesium hydroxide taken 1
10:09:09to 3 hours after meals and separately
10:09:11from other medications.
10:09:13Histamine 2 receptor antagonists like
10:09:15renitadine or famodine and proinetics
10:09:18such as metylopramide which enhance
10:09:20esophageal and stomach motility. Monitor
10:09:23carefully for extraal symptoms with
10:09:25proinetics. Therapeutic management
10:09:27includes lifestyle changes such as
10:09:29avoiding trigger foods and large meals,
10:09:31waiting 2 to three hours after eating
10:09:33before lying down, elevating the head of
10:09:35the bed 6 to 8 in, weight loss, and
10:09:38wearing loose clothing. In severe cases,
10:09:40surgical intervention known as fund
10:09:42application may be required where the
10:09:44stomach is wrapped around the esophagus
10:09:46to prevent reflux.
10:09:52Now, let's discuss some key nursing
10:09:54responsibilities you need to remember
10:09:56for the ENLEX exam. First, when caring
10:09:59for patients with esophageal issues,
10:10:01it's crucial to monitor closely for
10:10:03complications such as Barrett's
10:10:05esophagus, which is a precancerous
10:10:07condition, esophagitis, and
10:10:08strictctures.
10:10:10Additionally, educating patients on
10:10:11dietary changes, strict medication
10:10:13adherence, and proper positioning after
10:10:15meals is very important. In severe
10:10:17cases, always assess the patient's risk
10:10:19for aspiration. Also, keep a close eye
10:10:22on side effects of medications,
10:10:23particularly protein pump inhibitors,
10:10:25which can increase the risk of fractures
10:10:27and claustrdium diffosil infection.
10:10:30Next, let's talk about esophageal
10:10:32veraces. These are dilated fragile blood
10:10:34vessels in the esophagus that occur due
10:10:36to increased pressure in the portal vein
10:10:39commonly caused by liver cerosis.
10:10:41Bleeding from these vessels is a medical
10:10:43emergency. Key risk factors include
10:10:46liver cerosis, alcoholism, hepatitis,
10:10:49and portal vein thrombosis. Patients
10:10:51typically present with sudden massive
10:10:53vomiting of blood known as hemmitesis,
10:10:56black terry stools called melenna, low
10:10:58blood pressure, rapid heartbeat
10:11:00indicating shock, abdominal swelling,
10:11:02and jaundice. Before diagnosis,
10:11:04endoscopy is considered the gold
10:11:06standard. Laboratory tests usually show
10:11:09decreased hemoglobin and hematocrit
10:11:11along with elevated ammonia levels
10:11:13indicating liver dysfunction. In
10:11:16emergency management, establishing
10:11:18introvenous access with a large board
10:11:19needle is essential for fluid
10:11:21resuscitation. Administer medications
10:11:23like octriotide or vasopressin to
10:11:26constrict blood vessels and reduce
10:11:27portal pressure. Endoscopic procedures
10:11:30like band loation or sclerotherapy may
10:11:32be necessary and balloon tampon is used
10:11:34for life-threatening bleeding. As a
10:11:37nurse, monitor closely for signs of
10:11:39shock, including rapid heartbeat, low
10:11:41blood pressure, and changes in
10:11:43consciousness. Maintain the airway to
10:11:46prevent aspiration in patients vomiting
10:11:47blood. Prepare for possible blood
10:11:49transfusions and educate patients on the
10:11:52importance of alcohol sessation to
10:11:54prevent recurrence. Before we get
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10:11:58struggle with ENLEX prep not because
10:11:59they aren't smart, but because they lack
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10:12:26And here's your golden moment. It's 70%
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10:12:31and get started today. All right, let's
10:12:34jump into today's lesson. Now, let's
10:12:35move to peptic ulcer disease. This
10:12:38condition involves erosion of the
10:12:40stomach, esophagus or duodinal lining.
10:12:43Common causes include helicoacttor
10:12:45pylori infection, use of ensides and
10:12:48corticosteroids which weaken protective
10:12:50mucosal barriers, stress, smoking,
10:12:54alcohol use and conditions like Zolinger
10:12:56Ellison syndrome characterized by
10:12:58excessive acid production. Symptoms
10:13:01usually involve burning or gnawing
10:13:03stomach pain, heartburn, bloating,
10:13:05nausea, vomiting, and the presence of
10:13:08red blood or black tar stools. It's
10:13:11important to differentiate between types
10:13:13of ulcers. Gastric ulcers typically
10:13:16cause pain 30 to 60 minutes after meals,
10:13:18worsening when eating. Duodinal ulcers
10:13:21cause pain 1.5 to 3 hours after meals
10:13:24and at night, often relieved by eating
10:13:26or taking antacids. Serious
10:13:29complications include perforation and
10:13:30hemorrhage characterized by severe sharp
10:13:33stomach pain, a rigid abdomen, and signs
10:13:35of shock like rapid heartbeat and low
10:13:37blood pressure. Another complication is
10:13:40dumping syndrome occurring after stomach
10:13:42surgery causing dizziness, rapid
10:13:44heartbeat, sweating, nausea, and
10:13:46diarrhea. Dietary modifications include
10:13:49small frequent meals, avoiding fluids
10:13:51during meals, and adopting a high
10:13:53protein, high-fat, low carbohydrate
10:13:55diet. Medications include antibiotics
10:13:57like metroniditool, amoxicylin,
10:14:00chloriththramycin, and tetracycline for
10:14:02H pylori infection. Acid reducers like
10:14:05ranitine and fatodine. PPI like
10:14:08pantaprazole, antacids like magnesium
10:14:11hydroxide and mucosal protectants such
10:14:13as sucroate. Nursing responsibilities
10:14:15involve monitoring for signs of
10:14:17bleeding, assessing for perforation,
10:14:19encouraging complete antibiotic courses,
10:14:21and educating patients on dietary
10:14:23changes and avoiding NSAIDs. Moving
10:14:26forward, let's discuss gastritis, which
10:14:28involves inflammation of the stomach
10:14:30lining. It can be acute or chronic with
10:14:32chronic gastritis potentially leading to
10:14:34pernicious anemia and helicoacttor
10:14:36pylori infection. Risk factors include H
10:14:39pylori infections, NSAIDs,
10:14:41corticosteroids, alcohol, smoking,
10:14:43caffeine, stress and autoimmune
10:14:45conditions. Symptoms include upper
10:14:47abdominal pain, bloating, nausea,
10:14:49vomiting blood and black stools.
10:14:52Endoscopy with biopsy is the gold
10:14:54standard for diagnosis along with
10:14:56testing for H. pylori and checking for
10:14:58anemia. Management involves dietary
10:15:01changes like small frequent meals,
10:15:03stress reduction techniques, and careful
10:15:05monitoring for signs of gastric
10:15:06bleeding. Medications used are histamine
10:15:092 receptor antagonists such as
10:15:11femotadine, PPIs like pantaprazole,
10:15:14antacids taken separately from other
10:15:16medications, prostaglandon analoges like
10:15:18misoprotol not safe in pregnancy,
10:15:21mucosal protectants like sucralate and
10:15:23antibiotics for H. pylori. Monitor
10:15:26patients closely for complications such
10:15:28as gastric bleeding, dehydration, and
10:15:30pernicious anemia requiring monthly
10:15:32vitamin B12 injections. Finally, let's
10:15:35talk about non-inflammatory bowel
10:15:37disorders. A hernia occurs when bowel
10:15:39contents push through weakened abdominal
10:15:41muscles. Risks include being male,
10:15:43elderly, and having increased
10:15:45intraabdominal pressure from pregnancy,
10:15:47obesity, or heavy lifting. Patients may
10:15:50notice a lump or discomfort at the site
10:15:52and should avoid heavy lifting or
10:15:54straining. Irritable bowel syndrome or
10:15:57IBS is characterized by cramping,
10:15:59changes in bowel habits, bloating,
10:16:02belching, and mucus in stools.
10:16:04Management includes increasing fluids,
10:16:06fiber intake, avoiding stress triggers,
10:16:09and eliminating irritants like gas
10:16:10producing foods, caffeine, and alcohol.
10:16:14Medications such as elosetron for IBS
10:16:16with diarrhea and lubroone for IBS with
10:16:19constipation may also be used. Now,
10:16:21let's discuss intestinal obstruction. An
10:16:24intestinal obstruction prevents the
10:16:25normal flow of contents through the
10:16:26intestines. There are two types of
10:16:28intestinal obstructions we need to know
10:16:30about. First is mechanical obstruction
10:16:33which can be caused by physical issues
10:16:35like tumors, adhesions, hernas or
10:16:37diverticulitis. Second is non-
10:16:40mechanical obstruction which occurs due
10:16:41to problems like paralytic alas,
10:16:43vascular or neurogenic disorders or
10:16:46electrolyte imbalances. When assessing a
10:16:48patient with intestinal obstruction,
10:16:50findings differ depending on the
10:16:51location. If the small bowel is
10:16:53obstructed, the patient will present
10:16:55with sudden projectile vomiting that
10:16:57often has a fecal odor. But if the
10:16:59obstruction occurs in the large bowel,
10:17:01you might see diarrhea or ribbon-like
10:17:03stools moving around a blockage. On
10:17:06oscultation or listening with a
10:17:08stethoscope, you'll hear high-pitched
10:17:10sounds above the sight of obstruction
10:17:12and hypoactive or quieter sounds below
10:17:15it. The management and nursing
10:17:17responsibilities for intestinal
10:17:19obstruction include keeping the patient
10:17:21nothing by mouth, placing a nasogastric
10:17:23tube to decompress the stomach and
10:17:25providing introvenous fluids to maintain
10:17:27hydration. Oral hygiene should be
10:17:29performed every 2 hours to ensure
10:17:31comfort. Surgical interventions may be
10:17:33necessary such as colon resection or the
10:17:36creation of a colostomy. After surgery,
10:17:38nurses must clamp the NG tube before
10:17:40removing it and carefully assess the
10:17:42patients tolerance when clear liquids
10:17:44are reintroduced.
10:17:46Next we move on to inflammatory bowel
10:17:47disease also known as IBD. Two main
10:17:51types are important here. Ulcerative
10:17:52colitis and Crohn's disease. Starting
10:17:54with ulcerative colitis. This is chronic
10:17:56inflammation specifically affecting the
10:17:58mucosa and submucosa of the rectum and
10:18:01colon. Typical findings include pain in
10:18:04the lower left quadrant and patients
10:18:06might have 15 to 20 stools per day
10:18:08containing blood, mucus or pus. They
10:18:11also commonly experience abdominal
10:18:12distension and fever. Diagnostic lab
10:18:15tests will show decreased hematocrit and
10:18:17hemoglobin, increased ariththraite
10:18:20sedimentation rate, elevated white blood
10:18:22cells, and low albumin levels. Imaging
10:18:25methods for diagnosis include
10:18:27colonoscopy, barerium enema, and
10:18:29computed tomography. Management involves
10:18:32dietary changes such as a low- fiber,
10:18:34high protein, and high calorie diet.
10:18:37Surgical therapy might include
10:18:39callectomy or ilostomy. Medication
10:18:41therapy includes five amino salicylic
10:18:44acids such as sulfosalazine used to
10:18:46reduce inflammation. Corticosteroids
10:18:49which carry a risk of infection and high
10:18:51blood sugar or hypoglycemia.
10:18:53Imunosuppressants like cycllosporin
10:18:55which require careful monitoring for
10:18:57infections. Immunom modulators such as
10:18:59infleximab where patients should avoid
10:19:01crowds due to lowered immunity.
10:19:03antid-diarral like leramide which must
10:19:06be used cautiously to prevent toxic
10:19:07meggaolon and antimicrobials such as
10:19:10cyproloxin or metronitool.
10:19:14In comparison, Crohn's disease is
10:19:16another chronic inflammatory condition
10:19:18but it can affect any part of the
10:19:20gastrointestinal tract from mouth to
10:19:22anus. Typical findings here include
10:19:25right lower quadrant abdominal pain and
10:19:27around five loose stools per day
10:19:29containing mucus or pus. Patients might
10:19:32also experience sterhea which means
10:19:34fatty stools. Management strategies are
10:19:36similar to those for ulcerative colitis.
10:19:38Another important condition is
10:19:40diverticulitis which is inflammation of
10:19:42diverticula caused by trapped food,
10:19:44feces or bacteria. Patients typically
10:19:47report lower left quadrant abdominal
10:19:49pain, fever and chills. Nursing
10:19:52management involves dietary changes
10:19:54starting with clear liquids and low-
10:19:55fiber foods gradually increasing fiber
10:19:58intake. Patients should avoid foods such
10:20:00as nuts, seeds, and popcorn as these can
10:20:03worsen symptoms. It's crucial to monitor
10:20:05patients closely for complications like
10:20:07perforation indicated by sudden severe
10:20:09pain, fever, and vomiting. One serious
10:20:12complication of diverticulitis is
10:20:14peritonitis, presenting with a rigid
10:20:16board-like abdomen, nausea and vomiting,
10:20:19rebound tenderness, and rapid heart rate
10:20:22or tacocardia. If perodonitis is
10:20:24suspected, nursing actions include
10:20:26placing the patient in fowler's
10:20:28position, which means sitting up,
10:20:30administering oxygen, inserting an NG
10:20:32tube, and maintaining NPO status.
10:20:35Finally, let's explore two common
10:20:36gallbladder disorders known as
10:20:38choleiccyitis and choleolithasis.
10:20:40Colcyitis is inflammation of the
10:20:42gallbladder wall, typically caused by
10:20:44gallstones blocking bile ducts leading
10:20:46to bile backup and inflammation.
10:20:48Cololithsis refers simply to the
10:20:50presence of gallstones within the
10:20:51gallbladder. Common risk factors include
10:20:54being female, obesity, a high-fat diet,
10:20:57genetic factors, older age, rapid weight
10:20:59loss, pregnancy, hormone replacement
10:21:01therapy, and diabetes.
10:21:04Clinically, patients will experience
10:21:05sharp pain in the right upper quadrant,
10:21:07often radiating to the right shoulder or
10:21:09back, especially after highfat meals.
10:21:11They may also report digestive issues
10:21:13such as dispsia, burping, also known as
10:21:16erration, flatulence, nausea, and
10:21:18vomiting. Stool and urine changes
10:21:20include clay colored stools due to
10:21:22blocked bile flow, fatty stools,
10:21:24sterhea, dark-colored urine and itchy
10:21:27skin or paritus due to bile salts
10:21:30accumulation. Systemic signs often
10:21:32involve fever and increased heart rate
10:21:34or tacocardia. Lab tests usually show
10:21:37elevated white blood cells due to
10:21:39inflammation, increased bilerubin levels
10:21:41due to bile blockage and elevated amala
10:21:43and lipase if the pancreas is involved.
10:21:46Diagnostic methods include an ultrasound
10:21:48as the first line test, abdominal X-ray
10:21:51or CT scans to detect calcified stones,
10:21:53and a hepidiliary scan to assess
10:21:56gallbladder function. Treatment options
10:21:58include lithotripsy, a shockwave therapy
10:22:01suitable for small cholesterol-based
10:22:02stones in patients who cannot undergo
10:22:04surgery. Colystectomy or gallbladder
10:22:07removal performed laparoscopically with
10:22:09a short hospital stay or through open
10:22:12surgery requiring T- tube placement.
10:22:15Nursing responsibilities after open
10:22:17colcystectomy with T- tube placement
10:22:19include elevating the T- tube above
10:22:20abdomen level, monitoring and recording
10:22:23the drainage's color and amount,
10:22:25clamping the tube 1 hour before and
10:22:26after meals, and assessing stool color.
10:22:29Initially, stools may appear clay
10:22:31colored but should return to normal
10:22:33within a week. Post-operative diarrhea
10:22:35is also common. Dietary management posts
10:22:38surgery includes a low-fat diet and
10:22:39avoiding gas producing foods like beans,
10:22:42cabbage, cauliflower, and broccoli. A
10:22:45critical complication to watch for is
10:22:47parodonitis, a life-threatening
10:22:48infection resulting from gallbladder
10:22:50rupture. For anklelex purposes, nurses
10:22:52must closely assess patients for signs
10:22:54of bileduct obstruction, monitor for
10:22:57complications like infection or
10:22:58perodonitis after surgery, and educate
10:23:00patients clearly on post-operative care,
10:23:03dietary changes, and symptom management.
10:23:05Let's begin with pancreatitis, which is
10:23:08a serious condition that can cause
10:23:09severe complications if left untreated.
10:23:12First, we'll look at its
10:23:13pathophysiology. Normally, the pancreas
10:23:15secretes digestive enzymes that break
10:23:17down carbohydrates, proteins, and fats.
10:23:19However, in pancreatitis, these enzymes
10:23:22activate prematurely inside the
10:23:24pancreas, causing autodigestion and
10:23:26inflammation. Chronic pancreatitis
10:23:28eventually leads to fibrosis and loss of
10:23:30pancreatic function. The risk factors
10:23:32for pancreatitis include biliary tract
10:23:34diseases such as gallstones, alcohol
10:23:36use, gastrointestinal surgery, hyper
10:23:39lipidmia, high fat levels in the blood,
10:23:42hyperarathyroidism,
10:23:43trauma, penetrating ulcers, and
10:23:46medication toxicity. Patients with
10:23:48pancreatitis often present with severe
10:23:50epigastric pain that radiates to the
10:23:52back, left flank, or left shoulder. This
10:23:56pain typically worsens when lying down,
10:23:58but can be relieved by curling into a
10:24:00fetal position. Other gastrointestinal
10:24:02symptoms include nausea, vomiting, and
10:24:04weight loss. Additionally, there are
10:24:07notable skin signs such as Turner sign,
10:24:09which is bruising on the flanks and
10:24:11Cullen sign, which is bruising around
10:24:13the belly button area. Patients may also
10:24:15have jaundice, acites, fruity smelling
10:24:17breath due to keto acidosis, and signs
10:24:19of low calcium such as tetany indicated
10:24:21by positive trus and chvast signs.
10:24:24Laboratory tests for pancreatitis
10:24:26typically show elevated amalayise and
10:24:29lipase levels, elevated white blood cell
10:24:31counts indicating inflammation or
10:24:33infection, decreased calcium and
10:24:35magnesium levels due to the
10:24:36soponification process, elevated liver
10:24:39enzymes and bilarubin and hypoglycemia
10:24:41due to damage to insulin producing
10:24:43cells. Management involves both acute
10:24:45and long-term care. During acute
10:24:48episodes, patients are kept on nothing
10:24:50by mouth status to rest the pancreas,
10:24:52receive total parental nutrition
10:24:54intravenously, are provided pain relief
10:24:56with opioids, and have fluid and
10:24:58electrolyte balance closely monitored.
10:25:00Long-term care includes a bland low-fat
10:25:02diet, avoiding caffeine, alcohol, and
10:25:05smoking, regularly monitoring blood
10:25:07glucose, administering insulin when
10:25:09necessary, and taking pancreatic enzyme
10:25:12supplements with meals and snacks.
10:25:14Complications of pancreatitis can
10:25:16include pseudocysts from fluid leakage
10:25:18and type 1 diabetes malitis due to
10:25:20damaged pancreatic cells. Nursing
10:25:23responsibilities for pancreatitis
10:25:25involve monitoring for hypocalcemia
10:25:27symptoms, managing pain effectively,
10:25:29checking blood glucose regularly, and
10:25:30administering insulin if needed, and
10:25:32educating the patient about dietary
10:25:34restrictions and the importance of
10:25:36avoiding alcohol. Next, let's discuss
10:25:38hepatitis and cerosis. Two significant
10:25:40liver disorders with long-term health
10:25:42effects. Hepatitis is primarily caused
10:25:45by viral infections. Although drugs and
10:25:47toxins can also be responsible. There
10:25:49are three main types. Hepatitis A
10:25:52transmitted through the fecal oral root
10:25:53by contaminated food or water and
10:25:55preventable by vaccination. Hepatitis B
10:25:58spread through blood and body fluids,
10:26:00sexual contact, intravenous drug use or
10:26:02from mother to child also
10:26:04vaccinereventable. and hepatitis C
10:26:07transmitted mainly through blood and
10:26:08body fluids, often from intravenous drug
10:26:10use or sexual activity with no available
10:26:13vaccine. Risk factors for hepatitis
10:26:15include intravenous drug use,
10:26:17unprotected sex, tattoos, piercings,
10:26:20contaminated food or water, travel to
10:26:22areas with poor sanitation, and living
10:26:24in crowded conditions. Symptoms
10:26:26typically include flu-l like feelings,
10:26:28fever, vomiting, dark urine, clay
10:26:30colored stools, and jaundice. Laboratory
10:26:32tests usually reveal elevated liver
10:26:34enzymes A and ALT above 40 and Billy
10:26:38Rubin levels greater than one. Cerosis
10:26:41occurs when chronic inflammation leads
10:26:42to liver scarring. Types of cerosis
10:26:45include post- necrotic cerosis from
10:26:47viral hepatitis, lenex cerosis resulting
10:26:50from chronic alcohol use and biliary
10:26:53cerosis due to chronic bileduct
10:26:55obstruction or autoimmune diseases.
10:26:57Complications of cerosis include hpatic
10:27:00encphylopathy causing confusion, hand
10:27:02tremors called asterexis and coma,
10:27:04gastrointestinal bleeding from
10:27:06esophageal veraces, acites, jaundice,
10:27:10spider angiomas, severe itching called
10:27:13puritis and musty or sweet smelling
10:27:15breath known as feter hpaticus.
10:27:18Nursing care includes positioning
10:27:19patients upright at about 30°, elevating
10:27:22the legs to reduce swelling, and
10:27:24recommending a diet high in
10:27:26carbohydrates and protein, but low in
10:27:28fat and sodium. Nurses must monitor
10:27:31closely for signs of encphylopathy.
10:27:33Administer laculose to bind ammonia and
10:27:36maintain strict intake and output
10:27:37records and daily abdominal
10:27:39measurements. For the ENCLEX exam,
10:27:41nurses should frequently assess
10:27:43neurological status, monitor for
10:27:44bleeding and fluid accumulation, educate
10:27:47patients about lifestyle changes,
10:27:49including avoiding alcohol and adhering
10:27:51to dietary guidelines, and ensure
10:27:52compliance with immunosuppressive
10:27:54medications following liver
10:27:56transplantation.
10:27:57Finally, let's examine key renal
10:27:59diagnostic procedures. Laboratory tests
10:28:02include measuring creatinine levels,
10:28:04which are the most specific indicators
10:28:05of kidney function. Normal creatinine
10:28:08ranges from 0.6 6 to 1.2 mg per
10:28:11deciliter in men and 0.5 to 1.1 in
10:28:15women. Elevated creatinine indicates
10:28:18kidney disease, acute kidney injury,
10:28:20chronic kidney disease or glomealonitis.
10:28:23Blood ura nitrogen abbreviated as BU N
10:28:26normally ranges between 10 to 20 milligs
10:28:29per deciliter and can be increased due
10:28:31to dehydration, kidney disease, heart
10:28:33failure, or a high protein diet. Your
10:28:36analysis, ideally done with an early
10:28:38morning sample for accuracy, evaluates
10:28:40color, clarity, pH, protein, glucose,
10:28:44ketones, specific gravity, red and white
10:28:46blood cells, and bacteria. Abnormal
10:28:49findings like protein ura suggest kidney
10:28:52disease. Glucose in urine indicates
10:28:54diabetes. Ketones indicate diabetic keto
10:28:57acidosis. And white blood cells or
10:28:59bacteria suggest urinary tract
10:29:01infections. Red blood cells in urine
10:29:04point toward trauma, infection, or
10:29:06kidney stones. Imaging studies include
10:29:08CT scans with contrast, which carry a
10:29:11risk of contrastinduced kidney injury.
10:29:14So, patients should increase fluid
10:29:15intake afterward. If patients are
10:29:18allergic to iodine or shellfish,
10:29:20alternative imaging methods or
10:29:21premedication with antihistamines and
10:29:23corticosteroids are used. Cystoscopy or
10:29:26systothoscopy provides direct
10:29:28visualization of the bladder and
10:29:30urethra. Preparation includes nothing by
10:29:33mouth after midnight and bowel cleansing
10:29:35with laxatives or enemas. Post-procedure
10:29:38care involves monitoring for mild
10:29:40bleeding, signs of infection, urinary
10:29:42retention, and bladder perforation.
10:29:44Excoratory urography or introvenous
10:29:46pyogram visualizes renal structures.
10:29:49Preparation involves fasting after
10:29:51midnight and bowel cleansing.
10:29:53Post-procedure includes increasing fluid
10:29:55intake to clear the contrast dye and
10:29:57monitoring for allergic reactions or
10:29:58kidney damage. Diialysis, including
10:30:01hemodiolialysis and periteneal
10:30:03diialysis, is a life-saving procedure
10:30:05used when kidneys fail. Dialysis helps
10:30:07remove excess fluids, electrolytes, and
10:30:09waste products from the body. It's
10:30:12important to understand the types of
10:30:14complications and nursing care,
10:30:15especially when preparing for the
10:30:17enclelex. First, let's talk about
10:30:19hemmoiolysis. It requires vascular
10:30:21access through an arteriovenenous
10:30:23fistula, graft, or central venus
10:30:25catheter. Typically, it's performed
10:30:27three times per week, each session
10:30:28lasting around 3 to 5 hours. Nurses have
10:30:31several responsibilities for patients
10:30:33receiving hemmoiialysis. Before
10:30:35diialysis, it's important to assess the
10:30:37fistula or graft by feeling for a
10:30:38thrill, which is a vibration, and
10:30:41listening for a brute, which is a
10:30:42whooshing sound. Remember, never use the
10:30:45access arm for taking blood pressure,
10:30:47giving injections, or starting
10:30:48introvenous lines. Prior to diialysis,
10:30:51nurses should monitor vital signs,
10:30:52patient weight, blood ura nitrogen,
10:30:54creatinine electrolytes, and hematocrit
10:30:57levels. During the diialysis session,
10:30:59watch closely for complications such as
10:31:01low blood pressure, muscle cramps,
10:31:03vomiting, or bleeding. Because hepin is
10:31:06used to prevent clotting during
10:31:07diialysis, nurses should always have
10:31:09protein sulfate ready as an antidote.
10:31:12After diialysis, comparing pre and post
10:31:14dialysis weight helps determine fluid
10:31:16removal. Monitor patients carefully for
10:31:19hypotension and electrolyte imbalances.
10:31:22It's essential to encourage increased
10:31:24protein intake after diialysis since
10:31:26dietary restrictions from before
10:31:28diialysis no longer apply. Patients
10:31:30should avoid lifting heavy objects,
10:31:32compressing or sleeping on the access
10:31:34arm and should regularly perform hand
10:31:36exercises to help mature the fistula.
10:31:38Complications of hemodialysis include
10:31:41clotting or infection of the access site
10:31:43which can be prevented with
10:31:44anticoagulants and strict sterile
10:31:47technique. Another complication is
10:31:49disequilibrium syndrome caused by rapid
10:31:52fluid and electrolyte shifts leading to
10:31:54cerebral edema. Symptoms include
10:31:56headaches, nausea, vomiting, altered
10:32:00mental status and seizures. Nurses
10:32:02should slow the diialysis rate and
10:32:04administer anticonvulsants as needed.
10:32:06Hypotension may occur requiring
10:32:07intravenous fluids, lowering the head of
10:32:10the bed or slowing the diialysis
10:32:11process. Anemia can happen due to blood
10:32:14loss and reduced irriiththropoin
10:32:15production managed by administering
10:32:17ariththropoid and iron supplements.
10:32:20There is also risk of infectious
10:32:21diseases like hepatitis B, hepatitis C
10:32:24and HIV due to blood exposure.
10:32:28Next is peral diialysis. Commonly used
10:32:30when vascular access isn't possible,
10:32:32especially in older adults or patients
10:32:34with cardiovascular disease. During this
10:32:37procedure, a hypertonic dialysate
10:32:39solution is instilled into the paradal
10:32:40cavity, allowed to dwell, and then
10:32:43drained. It can be done at home as
10:32:45continuous ambulatory paradal diialysis
10:32:48or overnight as automated peral
10:32:50diialysis.
10:32:52For nurses, it's important to educate
10:32:54patients before the procedure that
10:32:55feeling fullness or mild discomfort
10:32:58during the dwell phase is normal. During
10:33:00diialysis, monitor inflow versus
10:33:02outflow. Output should be equal or
10:33:05greater. Normal diialysate drainage is
10:33:07clear to slightly yellow. Cloudy
10:33:08drainage signals infection. Keep the
10:33:10drainage bag lower than the abdomen and
10:33:13warm the dialysate to prevent cramping.
10:33:15Complications of peritineal diialysis
10:33:16include peritonitis which presents as
10:33:19fever, cloudy dialysate, rigid abdomen
10:33:21and purilent drainage. Immediate
10:33:24interventions include sterile technique
10:33:26and antibiotics.
10:33:28Protein loss requires increasing dietary
10:33:30protein intake. Hypoglycemia can occur
10:33:33requiring regular blood sugar
10:33:34monitoring. Poor dialysate flow caused
10:33:37by obstruction, constipation, or fibbrin
10:33:39clots can be managed by milking the
10:33:41tubing using stool softeners and
10:33:43encouraging a high-fiber diet. Kidney
10:33:46transplantation is the definitive
10:33:47treatment for endstage kidney disease.
10:33:50Postoperatively, nurses should monitor
10:33:52urine output closely, ensuring it's more
10:33:54than 30 ml per hour. An abrupt decrease
10:33:57may indicate rejection or obstruction,
10:33:59infection prevention is crucial.
10:34:01Regularly assess for fever, difficulty
10:34:03breathing, redness or drainage at the
10:34:06incision site. Watch carefully for signs
10:34:08of rejection like fever, high blood
10:34:10pressure and pain at the graph site and
10:34:12administer immunosuppressants such as
10:34:14cycllosporin, tacrolymus, basiliximab or
10:34:18tlyismab as prescribed. Respiratory care
10:34:21including turning, coughing and deep
10:34:22breathing helps prevent pneumonia.
10:34:25Maintaining bladder irrigation is also
10:34:27essential. Patient education after
10:34:29kidney transplant includes following a
10:34:30low-fat diet to control cholesterol,
10:34:33high fiber intake to prevent
10:34:34constipation, increased protein due to
10:34:36imunosuppressant use, and avoiding
10:34:39concentrated sugars and carbohydrates to
10:34:41prevent diabetes. Patients should avoid
10:34:43contact sports to reduce the risk of
10:34:45kidney trauma. Rejection can be
10:34:47hyperacute occurring within 48 hours and
10:34:49irreversible acute occurring between 1
10:34:52week to two years managed by increasing
10:34:54immunosuppressants
10:34:55or chronic occurring over months to
10:34:57years with gradual loss of kidney
10:34:59function requiring supportive care.
10:35:02Polycystic kidney disease is a genetic
10:35:04disorder marked by fluid-filled cysts in
10:35:06the kidneys progressively impairing
10:35:08kidney function. It can be autotosomal
10:35:10dominant, the most common form, or
10:35:12autotosomal recessive, which is rare and
10:35:14severe in infancy. Early signs include
10:35:17high blood pressure, blood in the urine
10:35:19from cyst rupture, flank pain, kidney
10:35:21stones, frequent nighttime urination,
10:35:23and changes in urine volume. Kidneys
10:35:25become enlarged and palpable,
10:35:27progressing to endstage renal disease,
10:35:29typically by ages 50 to 60.
10:35:31Complications include hypertension, cyst
10:35:34rupture, chronic kidney disease,
10:35:36cerebral aneurysms risking hemorrhagic
10:35:38stroke, and cysts in the liver or
10:35:40pancreas. Ultrasound is typically the
10:35:42first line diagnostic tool, while CT
10:35:44scan can detect cysts more accurately.
10:35:47Nursing management involves controlling
10:35:49blood pressure, ensuring fluid intake of
10:35:512 to three liters daily, managing pain
10:35:53preferably with acetaminophen,
10:35:55preventing urinary infections, promoting
10:35:57a low sodium diet, and considering
10:35:59diialysis or kidney transplantation in
10:36:02endstage renal disease. Genetic
10:36:04counseling is also advised for family
10:36:05members. Finally, acute kidney injury is
10:36:08a sudden loss of kidney function leading
10:36:10to fluid retention, electrolyte
10:36:12imbalance, and waste buildup. It can be
10:36:14reversed if treated promptly. Acute
10:36:17kidney injury progresses through three
10:36:19phases. The oliguric phase lasting one
10:36:21to three weeks with reduced urine
10:36:22output, fluid overload and electrolyte
10:36:24disturbances. The diuretic phase lasting
10:36:272 to 6 weeks marked by increased urine
10:36:29output and risks of dehydration and
10:36:31electrolyte imbalances. And the recovery
10:36:34phase lasting up to 12 months where
10:36:37kidney function gradually normalizes. In
10:36:40this section, we will discuss the types
10:36:41of acute kidney injury along with their
10:36:43causes and management strategies. First,
10:36:46we have the prennal type which is caused
10:36:49by decreased blood flow to the kidneys.
10:36:51Common causes include shock, hypoalmia,
10:36:54which means low blood volume, renal
10:36:56artery stenosis, sepsis and heart
10:36:59failure. In this case, the nursing role
10:37:01is focused on restoring blood flow and
10:37:03profusion by administering intravenous
10:37:05fluids and vasopressors as well as
10:37:07closely monitoring blood pressure.
10:37:10Second, we have the intrarenal type
10:37:12which involves direct damage to the
10:37:14kidneys. Causes of intrarenal injury
10:37:16include nephrotoxic drugs like
10:37:18non-steroidal anti-inflammatory drugs,
10:37:20amunoglycosside antibiotics, contrast
10:37:22dyes used in imaging, heavy metal
10:37:24exposure, acute glomealonitis, and
10:37:26trauma. Nurses play a key role by
10:37:28discontinuing nephrotoxic medications,
10:37:30closely monitoring urine output, and
10:37:32administering corticosteroids if the
10:37:34injury is due to inflammation. Third is
10:37:37the post-renal type caused by an
10:37:38obstruction of urine flow. This can
10:37:40happen due to kidney stones, tumors, an
10:37:42enlarged prostate, also known as benign
10:37:44prostatic hyperplasia or a neurogenic
10:37:47bladder. Nurses typically manage this
10:37:49condition by inserting a urinary
10:37:51catheter if needed and facilitating
10:37:53procedures to remove the obstruction
10:37:54such as surgery or lithotripsy.
10:37:57Now let's look at laboratory findings
10:38:00and diagnostics associated with acute
10:38:02kidney injury. Creatine levels will be
10:38:04elevated and serve as the most specific
10:38:06marker. Blood ura nitrogen or BUN also
10:38:10increases rapidly sometimes reaching
10:38:11levels between 80 to 100 within 1 week.
10:38:15Electrolyte disturbances like
10:38:16hypercalemia, metabolic acidosis,
10:38:18hyponetriia and hypocalcemia are
10:38:21commonly observed. Ur analysis in
10:38:24intrarenal acute kidney injury often
10:38:26shows casts and protein ura. Treatment
10:38:28and nursing care involve careful fluid
10:38:30management either restricting or
10:38:31replenishing fluids depending on the
10:38:33phase of injury. Diuretics such as
10:38:35fioymide may be used if oligura meaning
10:38:38very low urine output persists. Nurses
10:38:41must closely monitor electrolytes,
10:38:43treating high potassium levels with
10:38:44medications like kioxilate or insulin.
10:38:47Dialysis might be necessary in cases of
10:38:49severe electrolyte imbalances or uremia.
10:38:53Dietary management includes a diet low
10:38:55in potassium, phosphate, sodium, and
10:38:57magnesium along with a high protein diet
10:38:59to prevent muscle wasting. Next, let's
10:39:01discuss chronic kidney disease, also
10:39:03called CKD. CKD is characterized by
10:39:06progressive and irreversible kidney
10:39:08function loss. frequently caused by
10:39:11diabetes or hypertension eventually
10:39:13leading to endstage renal disease or
10:39:15ESRD.
10:39:17Key risk factors for developing CKD
10:39:19include diabetes malitis which is the
10:39:21leading cause followed closely by
10:39:23hypertension. Other risks include a
10:39:25history of acute kidney injury,
10:39:27long-term use of nephrotoxic drugs like
10:39:30NSAIDES, contrast dyes, amoglycosides,
10:39:33autoimmune conditions such as lupus and
10:39:35older age due to decreased renal reserve
10:39:37and higher dehydration risk. Chronic
10:39:40kidney disease is classified into five
10:39:41stages based on the glomemeular
10:39:43filtration rate or GFR. Stage one has a
10:39:46GFR greater than 90 indicating kidney
10:39:49damage but normal function. Stage two
10:39:52ranges from 60 to 89 representing a mild
10:39:54decrease. Stage three includes a
10:39:56moderate decrease in function with GFR
10:39:58between 30 and 59 where symptoms
10:40:00typically start to appear. Stage four
10:40:03has a severe decrease with GFR between
10:40:0515 and 29, indicating that diialysis
10:40:07preparation should begin. Finally, stage
10:40:10five is endstage renal disease with a
10:40:12GFR below 15 requiring diialysis or
10:40:15kidney transplant. Clinical findings in
10:40:17CKD vary and can involve multiple
10:40:20systems. Neurologically, patients may
10:40:22experience lethargy, confusion, tremors,
10:40:25or jerky movements. Cardiovascular signs
10:40:28include hypertension, jugular vein
10:40:29distension, and heart failure.
10:40:31Respiratory symptoms may present as
10:40:33rapid breathing, crackles in the lungs,
10:40:35or cousall's breathing due to severe
10:40:36acidosis. Gastrointestinal symptoms
10:40:39include nausea, vomiting, and ureimic
10:40:42feeder, a urine-like breath odor. Skin
10:40:45issues such as itching known as paritis,
10:40:47and ureimic frost, white crystal
10:40:49deposits on the skin, are common.
10:40:51Additionally, anemia occurs due to
10:40:53reduced ariththropoid production. Labs
10:40:56and diagnostics for CKD typically show
10:40:58increased BUN and creatinine electrolyte
10:41:00imbalances like hypercalemia,
10:41:02hyperphospatia, hypocalcemia and
10:41:05metabolic acidosis. Urine analysis often
10:41:08reveals blood protein and diluted urine
10:41:11indicated by low specific gravity.
10:41:13Imaging such as kidney urer bladder
10:41:15x-rays also called kub along with CT and
10:41:18MRI scans assist in diagnosis. Nursing
10:41:21management includes daily weight
10:41:23monitoring, remembering that 1 kilogram
10:41:24of weight gain equals one liter of fluid
10:41:26retention. Dietary restrictions of
10:41:29sodium, potassium, phosphate, and
10:41:30magnesium are crucial while encouraging
10:41:33a high carbohydrate moderate fat diet.
10:41:35Nurses must monitor for signs of
10:41:37hypercalemia like peaked T- waves on an
10:41:39EKG and arhythmias. Administering
10:41:42arythropoin helps manage anemia and
10:41:44avoiding nephrotoxic agents like
10:41:46NSAides, contrast dyes and magnesium
10:41:48containing antacids is essential.
10:41:51Patient education on limiting fluid
10:41:52intake to about 2 liters daily, quitting
10:41:54smoking, and controlling blood pressure
10:41:56and blood glucose is also vital. Common
10:41:59medications used include arythropoadin
10:42:01to stimulate red blood cell production,
10:42:03ferrra sulfate to treat anemia, furmide
10:42:06to manage fluid overload, phosphate
10:42:09binders like calcium acetate and seamir
10:42:12to reduce phosphorus and
10:42:13anti-hypertensive medications such as
10:42:15ACE inhibitors and ARBs to protect
10:42:17kidney function. Diialysis is indicated
10:42:20when the GFR drops below 15 or in cases
10:42:23of severe hypercalemia, metabolic
10:42:25acidosis or significant fluid overload
10:42:28leading to conditions like pulmonary
10:42:29edema.

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